Many insurance plans cover eating disorder treatment, but coverage varies. Plans typically cover inpatient care, outpatient therapy, and nutritional counseling, but some may limit the duration or types of services.

Coverage often includes therapy (individual, group, and family), medical monitoring, nutritional counseling, and sometimes partial hospitalization (PHP) or intensive outpatient programs (IOP). However, some plans may restrict access to higher levels of care.

Many insurance plans have limits on the number of inpatient days or outpatient therapy sessions. Pre-authorization may be required for extended stays or certain treatments.

Insurance companies may deny coverage for eating disorder treatment due to:

• Lack of Medical Necessity: The insurer may claim the requested treatment is not medically necessary.

• Lack of Coverage: Some plans do not cover specific treatment levels (e.g., residential care).

• Step Therapy Requirements: Insurance may require trying a lower level of care before covering higher levels.

• Geographical Restrictions: The insurer may require treatment at in-network or closer locations.

Policy Limitations: Some plans do not explicitly include eating disorder treatment in their Explanation of Benefits (EOB).

Medicaid is a state-run insurance for low-income individuals. Coverage for these plans vary by state.

MediCare is federal insurance for individuals 65+ and those with qualifying disabilities. Coverage is more standardized across states.

Learn more about these plans on our Government Plans page.

In-network providers are those who are “preferred” or covered by your insurance plan. To find who is in your network:

• Call your Member Services number (on your insurance card) to request a list of in-network providers.

• Search your insurance provider’s website.

• If using the Health Insurance Marketplace, use the provider search tool.

• Contact your provider’s office directly to verify network status.

Depending on the insurance plan, there may be steps you can take to avoid taking on out-of-pocket costs. Call your insurance and ask about a Single Case Agreement (SCA), which allows in-network rates for an out-of-network provider on a case-by-case basis.

Return to our Main Insurance Hub Page to find templates.

If you do need to see a provider who is not in your network or out-of-network, there are additional and different steps you may need to take:

• If you must see an out-of-network provider, check if your plan has out-of-network benefits. Some insurance plans will cover out-of-network treatment but at a lower reimbursement rate. Patients may need to pay higher out-of-pocket costs, or the treatment provider may work with the insurance company for reimbursement.

• Some providers offer sliding scale fees for private pay patients.

• Treatment centers may negotiate a Single Case Agreement (SCA) with your insurance provider to secure coverage.

Insurance authorization for eating disorder treatment is when your insurance company decides if they will cover the cost of your treatment. This often includes checking if the treatment is necessary and meets their guidelines. You usually need approval before certain services are covered. If authorization is denied, you can appeal to try to get approval.

Insurance companies sometimes deny coverage for medically necessary treatments, such as higher levels of eating disorder care.

• If this happens, you have the right to appeal the decision.

• Your provider can help guide you through the appeal process.

• Insurance companies are required to provide information on how to file an appeal.

• Be persistent! Many denials are successfully overturned through appeals.

• If denied again, consult a legal aid or patient advocate.

Denials can be reversed—don’t give up! Advocate for yourself and seek support when needed.

Some insurance providers cover treatment in another state. Check your insurer’s list of in-network facilities before starting treatment.

• Call Member Services (number on your insurance card).

• Some plans have separate numbers for medical and behavioral health inquiries.

• Request a copy of your insurance benefits summary through your insurer’s website or your employer’s HR department.

Under the Affordable Care Act (ACA), insurance companies cannot deny coverage or charge higher premiums based on pre-existing conditions, including eating disorders. Before the ACA, some insurance plans could classify eating disorders as pre-existing conditions and deny coverage, but this is no longer allowed for most health insurance plans.

However, if you are dealing with short-term health plans or grandfathered plans (those purchased before March 23, 2010), they may still exclude pre-existing conditions. If your insurer refuses coverage based on a pre-existing condition, you may want to consult a legal expert or a patient advocate.