In October 2017, Attorney, Alicia Paulino-Grisham, presented a continuing education seminar to clinicians at the Alliance for Eating Disorders Awareness regarding the health insurance claims and litigation process.
The course discussed the role of mental health providers in the health insurance claim process, from the inception of a claim for eating disorder treatment benefits through a lawsuit. The course was designed to assist mental health providers in understanding the nuances of the health insurance claim process, as well as prepare them for participation in the claim process at each stage of the claim. The course explored how to effectively advocate for a patient with an eating disorder seeking treatment beginning with the initial assessment and application for treatment benefits, the documentation of the appropriate level of care for eating disorder treatment, through a claim denial and litigation. It included a discussion of effective and appropriate documentation of an eating disorder patient’s symptoms and treatment. Further, the course addressed effective participation in “peer-to-peer” communications throughout the claim process (i.e., discussions with the insurance company mental health reviewer and/or responding to an insurance company’s mental health reviewer), best practices for responding to insurance company inquiries, how to aide patient’s in the submission of administrative appeals when claims are denied, and common insurance company investigation techniques to be aware of.
Moreover, the course explored the law governing health insurance claims (both under the federal statute, “ERISA,” and state insurance contract laws) and the filing of a lawsuit when an eating disorder patient’s health insurance benefits have been denied.
Attorney Paulino-Grisham was honored to be asked to prepare and present the continuing education seminar and enjoyed the exchange of ideas with the mental health clinician attendees.