Will My Insurance Pay for Obesity Counseling?

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Will my insurance pay for my counseling regarding obesity, disordered eating or food addiction?

The answer is – it depends. With obesity rates climbing, the American Medical Association declared Obesity as a disease in 2013. With this change also came the cry for insurances to cover for preventative and treatment services for those afflicted with obesity issues.  Depending on the insurance, a wide variety of services for prevention and treatment may be available including: bariatric surgery, gastric bypass surgery, intensive counseling, formal weight loss programs, group treatment sessions, health coaches and nutritionist interventions.

Who is eligible for reimbursement?

Most patients will require a screening to see whether or not they meet the requirements for obesity. Most clinics still utilize the BMI scale to measure for obesity and this has been found an acceptable way for medical professionals to diagnose patients. Mental health counselors may also diagnose patients based on behavioral assessment via the Diagnostic Manual. A diagnosis of Binge Eating Disorder, Bulimia, or other eating disorder may also help patients meet criteria for reimbursement.

Why does my insurance company tell me I have to be seen by my doctor and my sessions with my counselor don’t count?

Many insurance companies now support the need for treatment of Obesity. However, restrictions require the patient be seen by the primary care physician in a primary care setting. This restricts individuals from seeking treatment from other health professionals such as licensed counselors, psychologists, dietitians and nutritionists. This has presented to be an ongoing issue with many arguing research supports behavioral intervention as a necessity in effective treatment for obesity related problems, an area in which medical doctors and primary care providers have little training.

How can I get my insurance to cover my visits to see my counselor?

Obesity has become a significant problem with nearly 1 out of 3 people affected. Research shows most people afflicted with obesity are also likely to suffer from Binge Eating Disorder, a diagnosable mental health issue. Binge Eating Disorder is characterized by recurrent episodes of consuming abnormally large amounts of food beyond fullness. Insurance companies are required to provide mental health coverage, however, many employers still make decisions regarding what types of problems are covered. The good news? More and more states are requiring eating disorders to be covered as part of coverage and also recommending weight not be the only factor in deciding if someone is eligible.

How do I discuss coverage with my counselor?

Many mental health providers offer a free consultation before you even begin your sessions. During your consultation, discuss insurance reimbursement with your counselor. He or she may have advice for you on how to get covered and may even be able to facilitate coverage. In addition, your counselor may have other payment options available to make treatment affordable for you.

 

How do I talk to my insurance about coverage for my obesity treatment?

  1. Familiarize yourself with your insurance policy or health benefit plan. Obtain a copy from your employer or insurance company if you don’t have one.

  2. Understand the insurance policy’s coverage for treatment at an in-network facility versus an out-of-network facility.

  3. Ask your insurance company for a list of in-network treatment facilities.

  4. If the insurance company has no in-network facilities in your area or state, ask your insurance company for a single case agreement with your preferred treatment facility in your area.

  5. Document that the treatment is medically necessary by providing your doctor’s written support, your own letter describing your need for treatment, and if available, letters of support from family members or co-workers.

  6. Document what forms of therapy and treatment you have exhausted by submitting copies of all treatment records to the insurance company.

  7. Ensure that your facility communicates with the insurance company in writing and retains records of correspondence.

  8. Keep records of all out-of-pocket expenses for future reimbursement.

  9. Find out if your state has a Mental Health Parity Law. The National Alliance on Mental Illness has a chart outlining the mental health parity laws for each state.

  10. Obtain a copy of the treatment facility’s license to determine if it qualifies as a hospital, skilled nursing facility, congregate living facility, or other health facility license through the state.

 

Source: https://www.eatingdisorderhope.com/health-insurance-coverage-for-binge-eating-disorder

 

Does Madden Wellness accept insurance?

Madden Wellness does not direct bill for insurance. However, we do provide you with a superbill, a medical receipt in which you can submit to your insurance for reimbursement.

What if my insurance doesn’t reimburse and I can’t pay?

There may be several other options available to you even if your insurance does not reimburse you. Talk to your counselor or health care provider about a payment plan, sliding scale fees or another payment arrangement. In the meantime, continue to discuss options with your insurance provider and keep all records of your treatment.

Madden Wellness is a partner at Open Path Collective, a service which allows clients to pay one monthly payment towards sessions, a convenient and cost effective way to seek treatment.

Madden Wellness also offers Advance Care financing options for those needing affordable treatment. Many individuals may be eligible for 0% financing.

 

Additional Helpful Resources:

Decision Memo for Intensive Behavioral Therapy for Obesity

Health Insurance Coverage for Binge Eating Disorder

How to Fight for Coverage with an Eating Disorder

What is an Out-of-Network Provider?