Insurance Guidance and Support

You can contact your insurance company directly to better understand your benefits. Consider getting answers to the following questions.: 

• Do you have a PPO, EPO, or HMO? 

• Can you select an out-of-network provider or must you stay within the network? 

• Does your insurance representative understand the difference between eating disorder care vs. general mental health care? 

• What eating disorder treatment centers are available in your area? (Unfortunately, even if your treatment provider recommends that you enter a program for eating disorder treatment, this type of treatment may not be available in your area). 

• Are there travel restrictions limiting you to certain centers for care? 

• Are there financial risks associated with utilizing an out-of-network provider or a provider that represents as working with your insurance versus contracting with your insurance? 

• Are there exclusions (care not covered by your policy)? 

Our advice to you is this: you can never ask too many questions when it comes to insurance and paying for treatment. And we will help you every step of the way.

You have probably heard stories about individuals being denied treatment or may have even faced insurance challenges yourself in the past. One of the hurdles that some people face with insurance coverage is known as “utilization management”: your plan offers you specific covered benefits, but these services must be shown to be medically necessary.  

Here are some scenarios that come up from time to time: 

• Your treatment provider recommends residential treatment, but your insurance plan says that you don’t meet the “medically necessary guidelines” anymore. In this situation, your case will go under utilization review. 

• You may understand that you need approximately six weeks of care, but your insurance company is saying that they need progress updates every few days in order for you to stay in care with continued authorization.

If this occurs, our exceptional utilization review teams will do the work for you. Here’s how it works: 

• Our team can deliver (when necessary) high-quality, excellent clinical data to your insurance provider in support of your continued stay — so that you can continue working toward recovery.  

• Our licensed clinicians will work closely with your insurance provider every day to communicate the most important details to them and to show them your progress.  

• If needed, our medical doctors are also available to help get expedited appeals to your insurance company. 

This process is so important. When you start treatment, we will educate you on every aspect of this process and will update you frequently. Often, these steps can make the difference between getting substandard care and getting high-quality care. Please know that we will reach out to you to discuss any significant issues that may come up. 

If your insurance does not cover care at ERC, we will work with you and your family to establish self-pay rates. We will do our best to find a financial solution that allows you to get the care you need and deserve. This option is helpful if you are experiencing one of the following situations: 

• Don’t have health insurance 

• Lack eating disorder treatment benefits 

• Have high co-pays or deductibles 

• Are denied coverage by your insurance provider 

• Have a limited number of treatment days

In some cases, you can appeal to your insurance company for reimbursement of some of the fees. See below to learn more about scholarships for eating disorder care as well as free treatment options for some individuals. 

A single case agreement (SCA) is a way for your insurance plan to cover treatment with our team, even if you aren't in-network.

This may be an option when your insurance doesn’t have an in-network provider that offers the level of specialized eating disorder care you need, or when your care shouldn’t be interrupted.

We may explore a single case agreement if:

• There aren’t in-network providers with the right eating disorder expertise

• Stepping into or continuing treatment across levels of care

• Other treatment options haven’t worked or aren’t appropriate

If a single case agreement makes sense for your situation, our team will work directly with your insurance provider to request it and keep you informed along the way. While approval isn’t guaranteed, we advocate for you using clear clinical recommendations and a deep understanding of what insurers require.

If you or your loved one has more than one insurance plan, your coverage will be shared between them. This is called coordination of benefits.

Typically, one plan is your primary insurance (it pays first), and the other is your secondary insurance (it may help cover some of the remaining costs).

Our team will:

• Help confirm which plan is primary and which is secondary

• Check your benefits with both insurance providers

• Coordinate billing so everything is processed smoothly

Having more than one plan can sometimes lower your out-of-pocket costs, but we understand it can be confusing. We’ll walk you through it and make sure you understand what to expect before starting treatment.