Health Insurance for Individuals with Eating Disorders

Eating Disorders and Health Insurance

A regrettably self-conscious and media-pressured culture has resulted in millions of obsessive men and women who possess a mental illness that severely affects their physical health. While eating disorders can be paired with another type of psychological condition, they are themselves a dangerous, habit-forming, and potentially life-threatening problem. The most common of these conditions are anorexia nervosa, bulimia nervosa, and eating disorders otherwise not specified (EDNOS) such as binge-eating disorder, all of which stem from a mental illness. Half of the individuals who have an eating disorder also qualify as having depression, and due to malnutrition and other negative effects on the body, eating disorders have the highest death rate of any mental illness.

Eating disorders are incredibly damaging to every aspect of a person’s health. An anorexic may experience long term effects such as organ failure, brain damage, osteoporosis, infertility, heart damage, fatigue, and other attractive traits. Individuals with bulimia may permanently erode their tooth enamel, develop a chronic sore throat and swollen neck and jaw glands, as well as severe dehydration, and any number of gastrointestinal issues. Binge-eating typically leads to obesity, which has its own host of health problems, including immobility, damaged joints and ligaments, high cholesterol, and high blood pressure.

Treatment for eating disorders is simple in theory, yet complex in application. Training these individuals to think and eat in a healthy way can involve heavy psychotherapy, constant medical care and monitoring, nutritional counseling, as well as medications. Some patients use the inpatient approach to attempt to resolve a severe problem. As one can imagine, health insurance will have its own views towards these conditions, possibly resulting in a decline. As individuals with current or recurring episodes are typically declined, it is important to keep in mind that your health, your mind, and your wallet all suffer as a result of an eating disorder.

How Eating Disorders Affect Insurability

Individual health insurance eligibility all begins with the BMI chart. Those who are a healthy weight will be accepted, and those who are over, or under, the recommended weight for their height will likely be declined. At times, a health insurance company will settle on a rate increase for those who are slightly overweight, but those who fall short of the minimum BMI will be rejected. Though it is seemingly unfair, as people with extreme mental problems need coverage, too, those who are at a higher risk of a wide variety of health issues are too much for an insurer to take on. Most eating disorders lead to a myriad of serious medical conditions, and if they have not been controlled prior to enrolling in a health plan, you are likely going to need coverage from another source.

Health plans vary in their underwriting guidelines, though insurers are generally unanimous on declining malnourished individuals. Unless an applicant has reached a minimum BMI of 16, according to the underwriting criteria below, they will not be accepted. otherwise, the good news is that as long as you meet that minimum, this particular company will not penalize you with a rate increase. Others may not be so kind, as eating disorders have long been considered a pre-existing condition, which deems them eligible for rejection. This also means that even if you are accepted for coverage, the plan may refuse to cover treatment for your condition for a certain number of months.

The chart below is an excerpt from the underwriting guidelines of a current, commonly purchased Florida health plan. It indicates whether there will be a premium increase or an immediate decline issued to an applicant. As children under age 19 are unable to be rejected for coverage, this particular carrier increases their normal premium by 150 percent if the child is underweight. If the applicant is 19 or older, there is no luck getting on this policy. As these criteria are very black and white, and weight is the only measure of insurability, anyone with a history of an eating disorder over BMI 16 can pay a normal rate, hoping they are now taking care of themselves. The majority of insurers also underwrite in this way, according to an applicant’s height to weight ratio.

Health Plan Alternatives for Eating Disorders

As it is a possibility that anyone with an eating disorder may be declined due to their pre-existing condition, it is helpful to seek out other options for coverage. The present go-to for insuring people with illnesses is the Pre-Existing Condition Insurance Plan, as it is a substantial resource for the time being. Your available options all depend on your life and employment status, as plans may be available through your employer, or public coverage may be offered if you are suffering financially. Regardless, one of the following options should be able to fit your needs if individual health insurance is unavailable.

PCIP

The Affordable Care Act set up a high-risk pool in each state for people with conditions to have some source of insurance. It is important to remember a few things about PCIP prior to application: you must be uninsured for at least 6 months consecutively before applying, and it ends in a year from now. If you meet these basic criteria, you have a basic health plan at your fingertips once your application is approved. These comprehensive plans cover the majority of standard and major medical needs, without imposing any exclusion periods. PCIP also covers certain medications, mental health care, and specific health needs based on an applicant’s condition.

As these plans were set up by the health care law to be a temporary fix for those who would otherwise be uninsured due to their health, all PCIP members will have to switch to private coverage in 2014. This should actually be relieving to those members, as PCIP is rather limiting in provider choices and other certain elements of an established health plan. For the next year, people with eating disorders, whether anorexic or “other,” will be able to receive the care they need through PCIP without going bankrupt.

Group Health Plans

Employer coverage is the most commonly used form of health insurance, and if you have it available through your own job or your spouse’s, enroll away. As an individual with a medical problem, group plans will not discriminate against you personally for coverage, as they cannot decline any workers. However, rates may increase for the rest of the team as a result of a high-risk employee. Private health plans vary from one workplace to another based on what your employer decides to provide. Typically these are all comprehensive plans with major medical, preventive, primary, and specialist care included.

Group health plans may also cover medically necessary treatment related to your condition, though it depends on the specific plan with which you are provided. Mental health care is making its way into being a mandatory benefit, though not all plans have conformed as of yet. Consult your health plan for details on what types of care are covered before receiving treatment so you know which doctors to choose and how much it will cost.

Medicaid & CHIP

As eating disorders tend to affect the younger population more rampantly than older individuals, it is also important to know about Medicaid and the Children’s Health Insurance Program. If you and your family have a low income, this may be the health insurance plan for you. Anyone with a health condition is welcome to apply and will receive free coverage and free treatment through state and federal funding. CHIP usually is not entirely free, as the program accepts a higher income level of applicants. These programs definitely cover mental health care of all sort, though each state has a slightly different approach.

Check your state’s Department of Human Services for eligibility and benefit information. These programs are extremely beneficial to those who qualify, though like all insurance they do not cover everything. Certain medications may be excluded and require you to apply for a discount card. To ensure you get the care you need, speak with a benefits adviser at your local health department.

Health Reform & Eating Disorders

America’s next top health care law also helps individuals who have eating disorders, as the future holds a world where insurers no longer hold conditions against applicants. In 2014, the PCIP will not need to exist, as insurance companies will have to abide by new laws stating they cannot decline applicants for having an illness, however risky they might be. They also cannot issue exclusion periods or elimination riders. In addition, fore those who cannot afford coverage, there will be federal grants given to those who need help paying premiums for their mandatory coverage. Speaking of mandatory, the essential benefits list will go into effect for all insurers and health exchanges, including mental health care.

For those who have an eating disorder, this is great news, as they can receive coverage for no more than a healthy person. Insurers will also not be able to increase premiums by more than 10 percent. As for Medicaid, the program will expand in certain areas that choose to offer more low-income individuals public assistance. Health reform may be causing many disputes, but for those who are recipients, especially if you have a pre-existing condition or are a female, this law is in your favor. Once 2014 hits, we will see how the health care industry adapts to these changes and if all goes to plan.