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Why was the insurance claim for my eating disorder denied?

It took far too long for the medical community to realize that eating disorders require the same attention, compassion and treatment as any other disease or disorder. It took even longer to understand that there is more than just a physical component to these disorders. Those affected also need psychological support as well.

Even though insurance companies may provide benefits for both the physical and mental aspects of recovery, they may be separate under a policy. This could present a challenge when making a claim since many case managers do not understand the need for both aspects of care. For this reason, you may find yourself facing a denial of benefits.

Why you may receive a denial to your initial claim

A hard truth that many people must face is that if an insurance company can find a reason to deny your claim, they will probably do so. Below are the common reasons you may receive a denial:

  • Your prior attempts at treatment failed to help you beat your eating disorder.
  • The case manager believes you should try a less intense, and thus less expensive, form of treatment first.
  • The case manager may claim that you weigh too much to qualify for benefits.
  • On the other hand, the case manager may think you are not gaining enough weight.
  • You failed to consistently attend appointments.
  • Your behaviors have not changed quickly enough for the case manager.
  • The case manager believes you don't have the proper motivation.
  • You are not currently experiencing any complications as a result of your eating disorder.

Your claim may even be denied because you improved to a point where a lesser treatment would work better for you.

Improving your chances of avoiding a denial of your initial claim

Preparation is often key when it comes to submitting a claim for benefits from your insurance company. A thorough review of your plan may be a good first step. Another good practice involves amassing as much documentation as possible regarding your disorder. Any medical or mental health care professional you speak with will also have some sort of documentation you can use to substantiate your claim.

The more information your case manager has to work with, the greater the odds that your claim will provide you with the benefits you need. If you already filed a claim and received a denial, you don't necessarily have to accept it. You could appeal the decision. Considering the importance of the treatment you need, it may benefit you to find appropriate legal resources here in Fort Lauderdale.

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