HMO Rehab and Eating Disorder Coverage

The National Association of Anorexia Nervosa and Associated Disorders reports that as many as 24 million individuals in the United States are currently suffering from an eating disorder. The best way to overcome an eating disorder is to seek professional treatment. However, only 1 in 10 people affected receive treatment for their condition.

For some people, the cost of doctor visits and/or hospitalization is an obstacle to treatment. However, if you have an HMO insurance policy, a portion of your treatment expenses may be covered.

HMO Policy Basics

Like other insurance policies, most health maintenance organization (HMO) policies have a deductible, which is the amount you must pay for your own healthcare expenses during the year before your HMO eating disorder coverage will begin. Most HMO policies also have a coinsurance requirement. Coinsurance is the amount you will pay toward your treatment expenses after you have met your deductible. It is typically expressed as a percentage. For example, you may be personally responsible for 20 percent of your treatment, while your HMO eating disorder coverage will pay 80 percent. In addition to your coinsurance, you may also pay a copay for certain services, which is a flat fee due at the time of your appointment.

HMO Considerations

Several factors specific to HMO policies may have an effect on your HMO eating disorder coverage. Some of these factors include:

  • HMO Network - Like many other policies, HMO plans have a network of preferred providers. However, with an HMO policy, you won't receive any benefits if you use a provider from outside of this network.
  • Primary Care Physician - Some policies allow you to visit a specialist or schedule treatment without permission from your primary doctor. However, if you have an HMO policy, you must select a primary care physician, or PCP to direct all of your care. Visits to specialists and eating disorder treatment will be covered only if your PCP authorizes the services you receive.
  • Preauthorization - Some types of treatment may require the approval of your PCP and the HMO itself in order to qualify for HMO eating disorder coverage. Consult your plan documents to determine if preauthorization will be necessary for the treatment you need.

HMO policies can vary. If you need answers to specific questions about your policy, ask your insurance agent or contact the insurance company directly for more information.

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