Emblem Coverage for Eating Disorders

If you have a policy through EmblemHealth, it’s likely you’ll be able to have some treatments covered through the company’s mental health benefits. Still, as with all health insurance-related inquiries, there are a number of nuances and caveats involved. The exact level of coverage for your care will depend on the specifics of your plan.

For more specifics, you should speak with a representative from EmblemHealth or refer to your health care policy. But below are some of the general expectations you can have about what EmblemHealth will and will not cover.

Does EmblemHealth Cover Eating Disorder Treatment?

EmblemHealth doesn’t discuss many of the specifics of eating disorder treatment on their site, but they do provide mental health coverage, which typically extends to eating disorder treatment. 

In order to receive the most coverage possible, you will generally first need to have an official diagnosis of the condition. From that point, you can consult your doctors and the insurance company for more information on how to best proceed.

What Will EmblemHealth Cover for Bulimia Treatment?

Typically, when it comes to covering care for eating disorders or other related mental health conditions, an insurance company will require that treatment options be both evidence-based and necessary.

That means the methods must have been clinically tested and considered effective based on these analyses. More experimental treatments or those considered “holistic care” and not strictly necessary will likely not be covered, or require you to negotiate specifically with your insurance carrier.

It will likely also be easier to secure coverage for outpatient care, where patients live at home and commute to treatment centers. Some insurance companies will require you to have at least tried outpatient care before covering more intensive forms of care, including intensive outpatient programs or residential treatment. And even if you’re approved for a residential program, your care may only cover part of your stay at a residential treatment center.

Once again, the specifics of what EmblemHealth will cover for you should be included in your particular policy. Calling a representative from the company may also be a helpful way to understand your options.

Commonly Accepted Types of Eating Disorder Treatment

Medications are also sometimes prescribed as part of eating disorder treatment, especially when there’s a co-occurring condition involved. Medication may be covered by a different part of your health care plan, so it’s important to consult with EmblemHealth before proceeding with this type of care.

What Will EmblemHealth Not Cover for Eating Disorder Treatment?

EmblemHealth won’t usually cover treatments considered experimental, unsupported by medical evidence, or those that are deemed superfluous, or unnecessary. If a less expensive type of treatment exists, which can arguably be equally as effective, the insurance company may also decline to cover a more expensive type of otherwise comparable care.

Inpatient care, in particular, is generally difficult to secure coverage for. These programs are usually costly, so insurance companies typically demand a high burden of proof that they are necessary, and no cheaper options will help in the same way.

The longer your intended stay in inpatient care, the more difficult it can be to get covered, even if both you and your care provider agree it is the best treatment option for you. With some plans, you may need to regularly get re-approved for coverage during your stay at a residential care program. This is essentially verifying to your insurance provider that inpatient care is still needed on this short-term basis.

How to Start the Treatment Process Using EmblemHealth Coverage

You most likely won’t be eligible for coverage until you have an official eating disorder diagnosis. When you go in for this appointment, make sure the doctor you’re seeing is in-network for Emblem, as this is sometimes a requirement for eventual coverage.

The doctor who diagnoses you will also be able to help you develop a treatment plan. This is a crucial step of the process, as it serves as an official recommendation of the types of care or treatment you should have and qualify for.

Depending on their expertise, the doctor who helped diagnose you can sometimes provide at least some of that care, as well. If they’re in-network, this can be an especially smooth process. If this is not the case, the doctor can still often refer you to specific providers or programs that suit your needs.

Out-of-network care may also have some level of coverage, but likely coverage won’t be as extensive. You may also need to submit a claim to receive a reimbursement in these cases. If that’s so, you will need to pay for the treatment up front and out of pocket before you are later reimbursed at some level. You can read more about how to do this with EmblemHealth on this page.

Finding Treatment Centers in EmblemHealth’s Network

EmblemHealth makes it easy for people who have accounts with them to find doctors and other types of care providers in their network. Using this page, you can find some general information about their network or log in to get specifics relevant to your plan.

The company recommends logging into their site if you can, as this also makes it easier to get information about relevant partners who can provide covered care. [2]

But regardless of where you start your search, the most important thing is making that decision. Eating disorders are physically, mentally, and emotionally taxing conditions to deal with, and working through the complexities of insurance coverage is not an easy task to adopt on top of all that. But securing some coverage will help ensure your treatment journey is as smooth—and successful—as possible.