If you’re looking at your insurance card wondering if eating disorder treatment is covered, you’re not alone. Even though the card tells you your copay and deductible amounts, that’s merely a snapshot, not the full picture. Coverage for eating disorder treatment is based on many factors including type of plan, in- and out-of-network rules, level of care, medical criteria, behavioral health administration, and prior authorization.
But it is possible to get clarity without guessing and it is often possible to get coverage.
“One of the biggest misconceptions we see is that an insurance card tells you everything you need to know. In reality, coverage often depends on the level of care, authorization requirements, and medical necessity criteria—details that aren’t printed on the card. That’s why we encourage families to let us verify benefits and walk through their options clearly, step by step.”
— Chloe Godward, MS, LMFT (she/her), Director of Admissions, Galen Hope
Key Takeaways
- Eating disorder treatment is usually covered under mental health benefits, which many plans include. But coverage will vary depending on level of care and your specific insurance plan.
- The details and requirements that determine coverage (examples: prior authorization, medical criteria) are not listed on your insurance card.
- Your plan may have a separate behavioral health administrator or phone number that isn’t listed on your insurance card.
- The fastest way to get the answers you need is a verification of benefits (VOB) and a clinical review when needed.
Key Statistics
- An estimated 28.8 million Americans will experience an eating disorder at some point in their lives.
- A major report showed that, from 2018 to 2019, there were approximately 10,200 deaths associated with eating disorders (report includes modeling range).
- Federal parity protections generally require many health plans that offer mental health benefits to cover them comparably to medical/surgical benefits (though specifics vary by plan type and design).
The short answer: Often, yes—but it depends
Many insurance plans do include coverage for eating disorder treatment, but did you know two people can have the same insurer but have very different coverage? That’s because the specific plan (examples: employer plan or individual plan, PPO or HMO) and its rules can differ. The specifics of coverage depend on a variety of other factors too, such as:
- Whether a provider is in-network or out-of-network
- Whether the insurer concludes treatment is medically necessary (usually requires documentation that clinical criteria has been met)
- Recommended level of care (outpatient, intensive outpatient, partial hospitalization, residential)
A simple, clear guide to getting clarity about your benefits
Insurance benefits are complex and can’t be fully detailed on a small card. Below are steps to take and questions to ask customer service.
1) Request your certificate of coverage, Summary of Benefits and Coverage (SBC) or Summary Plan Description (SPD)
Ask your insurer (or human resources representative if you have an employer plan) for the documents that describe your plan’s behavioral health benefits.
2) Confirm the recommended level of care
Your plan’s coverage may vary depending on level of care.
- Outpatient therapy and nutrition support
- Intensive Outpatient (IOP)
- Partial Hospitalization (PHP)
- Residential
3) Ask about prior authorization, medical necessity, and other requirements for eating disorder treatment
Higher levels of care for an eating disorder commonly require:
- Insurer’s approval before admission or continued stay (prior authorization)
- Continued approvals based on medical necessity and progress (utilization review)
Even if benefits are available, approval often depends on whether the insurer agrees care is medically necessary. Under federal parity rules, you may have rights to request the plan’s criteria for determining necessity and the details behind denials (including for inpatient eating disorder treatment).
4) Ask about your full cost responsibility
Copays aren’t the only financial consideration. There’s also:
- Whether your deductible applies first
- Your financial responsibility after the deductible is met (coinsurance)
- The cost structures for in-network vs. out-of-network
- Benefit exclusions or limitations
5) Ask if behavioral health benefits are managed separately
Mental health/eating disorder benefits are sometimes administered by a behavioral health organization, even when the medical plan is through a larger insurer. This usually means there’s a separate phone number to call.
6) Let a treatment center run Verification of Benefits (VOB)
A good VOB will clarify the aforementioned details and more:
- In-network vs. out-of-network status
- Deductible, coinsurance, and estimated patient responsibility
- Whether prior authorization is required
- The correct contacts for behavioral health coverage
- Any limits on number of visits or days allowed
- Review processes
It’s important to know that while a VOB will help clarify options, it’s not a guarantee of coverage or payment. Final determinations usually depend on authorization and medical necessity.
Q&A About Eating Disorder Treatment Coverage
1) Does insurance usually cover eating disorder treatment?
Often, yes. Many insurance plans include mental health benefits and eating disorder care usually falls under those. But coverage does vary depending on plan, network, and level of care.
2) Why can’t I tell from my insurance card?
Because the card doesn’t include the complexities of coverage: deductibles, coinsurance, prior authorization requirements, plan exclusions, and medical necessity criteria. Those details can be found in your plan documents.
3) What if my insurance denies coverage or says treatment isn’t medically necessary?
Request the reason for denial, the plan’s medical criteria, and any related information. Then you—along with help from your provider or treatment team—can file an appeal according to your insurer’s process.
When to Seek Help
If you or a loved one is experiencing eating disorder symptoms—especially rapid change, medical instability, or escalating behaviors—don’t wait for perfect insurance clarity before reaching out.
Seek urgent medical care right away for symptoms like fainting, chest pain, severe weakness, confusion, dehydration, or inability to keep food down.
About Galen Hope
Galen Hope offers physician-led, individualized treatment programs for adolescents and adults of all genders struggling with eating disorders or complex mental health conditions. Our multidisciplinary teams take an integrated, whole-person approach to help clients stabilize in the acute stages and build the skills needed for long-term recovery.
Our team is also on hand to help you navigate insurance questions as you or your loved one explores care. Because benefits are rarely clear from an insurance card alone, we always recommend having our team complete a verification of insurance benefits so you can make an informed decision about treatment.
Families use their benefits in a variety of ways to help cover the cost of care, including pursuing out-of-network reimbursement, participating in regular utilization reviews (provided free of charge for families using insurance benefits), and initiating single-case agreements when clinically appropriate.
We are currently in-network with Optum, United Healthcare (UHC), PHCS, MultiPlan, ComPsych, Cigna, Evernorth, and First Health. We also accept private pay, and our contract with Optum may include commercial plans such as United, AvMed, and Oscar.
For out-of-network coverage, we work with many plans, including Blue Cross and others, which may cover a portion of the cost of care. Call us and we’ll do our best to help you find a path to the support you need.
We also accept private pay.
Learn more at galenhope.com or call 866-304-2955.