Medical Necessity is typically the most critical factor considered when seeking authorization from insurance companies for eating disorder treatment. Insurance companies look for evidence that the eating disorder is having medical consequences on the physical body; examples of this include low body weight, low heart rate, low blood pressure, and abnormal blood work. However, as you likely have observed in your child, eating disorders affect much more than just the physical body—they affect behavior, thinking, and emotion. Consequently, when insurance companies deny continued authorization of treatment, citing that a client “does not meet medical necessity,” parents and the treatment team may agree that more treatment is crucial for sustained recovery.
We, at Center for Discovery, do our absolute best to work with the insurance companies to ensure that our clients get an adequate length of treatment. Virtually all insurance plans evaluate continued treatment using their own guidelines for medical necessity. When a client is ready to transition to a lower level of care, we will help you find the right treatment option for your child. Unfortunately, it is not uncommon for clients to be denied authorization before they are ready and have met the vital therapeutic milestones detailed on the Recovery Report Card™. We know that once clients have shifted into making real progress, the benefits of another week or two of treatment can be invaluable. With this in mind, we will do everything we can to support you in securing an appropriate length of treatment for your child. If you are denied authorization, your therapist will discuss several options with you. These options may include working with the insurer to flex treatment benefits or using personal resources to cover continued treatment. Please know that when a family chooses to use personal resources, we discount our usual private pay rates to match the insurance rates and direct families to financing options that can make treatment accessible and affordable. We are committed to working with you to ensure that your child receives the best possible outcome from their treatment experience with us.