The short answer: Yes, most commercial health insurance plans cover residential eating disorder treatment when it's medically necessary. What you pay depends on your plan's network and benefits.
One of the first questions families and clients ask me, after establishing whether we can help, is some version of "How are we going to pay for this?" The confusion about the benefits on your plan, what to even ask your insurance plan, or the unknown total cost is the thing that keeps families and patients from picking up the phone.
So let me start with the good part: Most employer-funded and commercial health insurance plans really do cover residential eating disorder treatment! I will explain how coverage usually works, what to ask your insurer, and what insurance we accept at EDTC in Covington, Louisiana.
What is residential eating disorder treatment?
Residential treatment means living at the program and getting care around the clock, in a setting that feels a lot more like home than a hospital. It's for people who need more support than weekly therapy or even an intensive outpatient program can give. What we do at EDTC is bring the whole team together in one place: medical and psychiatric care, individual and group therapy, nutrition support, wellness programming and family healing. At EDTC in Covington, our residential program is for adult women. We treat anorexia, bulimia, binge eating disorder, ARFID, OSFED and co-occurring conditions.
Does insurance usually cover it?
Yes. It usually comes down to three things:
- Medical necessity. Your insurer reviews clinical information to decide whether residential care is the right level of treatment right now.
- Your plan's network. In-network programs usually cost less. Out-of-network care might be covered at a lower rate or might not be covered at all.
- Your benefits. Your deductible, coinsurance and out-of-pocket maximum set what you pay. The federal Mental Health Parity and Addiction Equity Act (MHPAEA) generally requires plans that cover mental health care to cover it on terms comparable to medical and surgical care. That includes eating disorder treatment, which falls under the behavioral health or mental health section of your plan. It doesn't guarantee approval. What it does mean is that your plan shouldn't treat an eating disorder as less serious than a physical illness. Some employer-funded commercial plans can be excluded from certain rules, so please call us at (985) 261-3382 to check your benefits quickly and for free.
What insurance EDTC accepts We're in network with most major commercial insurance plans, including most Blue Cross Blue Shield/Anthem plans, Cigna/Evernorth and Aetna, plus plans whose behavioral health benefits are managed by Magellan or Carelon (formerly Beacon), and other commercial and employer-funded plans. If yours isn't listed, please call anyway. In some cases, we can ask your insurer for a single case agreement, which lets out-of-network care be covered like in-network care.
We don't accept Medicaid, Medicare or other government plans, including TRICARE and VA Community Care. If that's your coverage, I'd still really encourage you to call. Our team will help you find a program that takes your plan, so either way you'll leave the call with a next step.
Questions to ask your insurance company
If you'd like to call your insurer first, here's what to ask:
- Does my plan cover residential treatment for eating disorders?
- Is Eating Disorder Treatment Centers (EDTC) in-network for my behavioral health benefits?
- Do I need prior authorization before admission?
- What's my deductible, and how much of it have I met this year?
- What's my out-of-pocket maximum?
- How much coinsurance is left for my plan year? (Coinsurance is usually a percentage you pay, up to your out-of-pocket maximum.) Do I have a copay per admission?
- Who manages my mental health benefits? (It's sometimes a different company than the one on the front of your card.)
Check the back of your card, too. The behavioral health number printed there usually gets you to the right person a lot faster than the main line.
Another option is to let EDTC check your benefits. Most patients and families find it easier to let us make that call. Our admissions team is specifically trained in working with insurance and will check your benefits for free.
We keep it confidential, and we usually have an answer for you within a few hours, often within minutes. Our team will explain in plain language what your plan covers and what you're likely to owe. All we need to get started is your insurance card and your date of birth.
If your insurance says no…
A denial isn't always the end of the road. Decisions can often be appealed, and our clinical team can sometimes send more information that changes the outcome. If you've already been denied, tell us, and we'll go through your options with you.
Other Frequently Asked Questions
Does insurance cover residential eating disorder treatment in Louisiana?
Yes, most commercial plans cover residential eating disorder treatment when it's medically necessary, and federal parity law generally requires mental health coverage comparable to medical coverage. Your network, deductible and out-of-pocket maximum decide what you pay.
How long will insurance cover a residential stay?
It depends on medical necessity. Insurers usually approve a set number of days, then review progress with the treatment team before approving more. It's worth asking any program how it handles those reviews with your insurer. At EDTC, we handle everything insurance-related and will keep you updated during your treatment process.
Does EDTC accept Medicaid or Medicare?
No. We don't accept Medicaid, Medicare or other government plans, including TRICARE and VA Community Care. If that's your coverage, call us anyway and we'll help you find a program that takes your plan.
What if my insurance plan is out of network?
Call us. In some cases, we can ask your insurer for a single case agreement, which lets out-of-network care be covered more like in-network care.
How do I check my eating disorder treatment coverage?
Call the behavioral health number on the back of your insurance card, or let us do it. Our recovery advocates verify benefits quickly, confidentially, and at no cost.
Call us to get started
Worrying about money is completely normal, and it shouldn't be the reason someone you love goes without care.
Call Eating Disorder Treatment Centers (EDTC) in Covington, Louisiana, at our 24/7 admissions line, (985) 261-3382, or verify your insurance online at https://www.edtcrecovery.com/admissions/.
A real person on our team will answer, day or night.
Need to Talk?
Contact our team for a confidential assessment and get the information you need to make an informed, compassionate decision.
About the author: Emily Meyers is a Licensed Professional Counselor in Louisiana and the Chief Executive Officer at Eating Disorder Treatment Centers. In her administrative roles, she works closely with insurance companies to develop in-network agreements and has worked in and supervised utilization management for many years. She has helped many families navigate the complexities of insurance coverage for treatment and is a fierce advocate for her patients and their families.