Eating disorders often leave patients facing difficult insurance hurdles

When she was 5 years old, Chevese Turner had her first episode of binge eating. Turner, now 44, recalls sneaking a box of ice cream cones from the kitchen and eating as many as she could, alone in her room.

This kind of behavior continued over the years, leaving her feeling shameful and guilty.

(Larry French/AP IMAGES FOR KAISER FAMILY FOUNDATION) - Chevese Turner speaks at the Timberline Knolls Binge Eating Disorder Workshop at the Bethesda Marriott on Saturday, Sept. 22. 2012 in Bethesda, Md. Chevese Turner says insurance coverage for her eating disorder has been spotty.

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“I realized that food was the one thing I could have for myself, and I could sort of escape,” said Turner, who lives in Annapolis. But “over time it became a way for me to disassociate from my problems or whatever I was trying to avoid.”

Binge-eating disorder is a condition that includes significant overeating brought on by depression or other emotional issues, according to mental health experts. Researchers estimate that about 3 percent of the nearly 14 million people with eating disorders are binge eaters. Other eating disorders include anorexia and bulimia.

For many of those who seek treatment for these disorders, getting a full range of insurance coverage can be difficult.

Mental health coverage, especially in individual plans, is often less generous than coverage for physical ills. (The federal mental health parity law does not apply to individual insurance policies and does not require treatment for specific disorders.)

In addition, treatment of eating disorders is complicated because it often involves medical care, mental health services and nutritional therapy, requiring a team of specialists — often a primary-care doctor, a therapist, a psychiatrist and a dietitian. Patients argue that insurers don’t adequately cover all those services, although estimates of how many patients receive coverage vary.

Turner, who has received treatment for binge-eating disorder for more than 20 years, says that sometimes her plans have covered treatments for depression but not many other services, such as nutritional counseling. At one point, she says, she paid up to $200 a week to meet with a dietitian. This back-and-forth between coverage and out-of-pocket costs led to gaps in her treatment.

“It took me a long time to get to anything that even looked like recovery,” Turner said.

The Eating Disorders Coalition tried unsuccessfully to get treatments for eating disorders included in the “essential health benefits” that insurance plans are required to provide, beginning in 2014, in the insurance marketplaces, or exchanges, being set up under the Affordable Care Act.

“Exclusion of eating disorders is all too common on the part of insurers seeking to limit interventions deemed non-essential,” the group wrote to federal officials in a January letter. “Despite being biologically based mental illnesses with potentially severe physical health ramifications, including death, eating disorders are all too often found on lists of benefit exclusions.

Life-threatening situations

The group noted that a survey of more than 100 eating disorder specialists found that “96.7 percent believe their patients with anorexia nervosa are put in life threatening situations” because treatments often are cut short when coverage is denied.