Aetna Eating Disorder Treatment Coverage

If you or a loved one are struggling with an eating disorder, dealing with your health insurance company may be the last thing you want to worry about.

But the healing process for these types of conditions generally takes time. And unfortunately, a number of eating disorder treatments, including intensive outpatient programs and inpatient treatment options, such as residential treatment, can be costly, making it difficult for most people to pay out-of-pocket for a full course of care.

So while dealing with health insurance companies can be frustrating, it can also lead to accessing the full breadth of treatment and care you or your loved one need.

Does Aetna Cover Eating Disorder Treatment?

In a word: Yes. Aetna will cover individualized treatment for some eating disorders. But, as with nearly all things related to health insurance, there are a number of details and caveats involved.

Aetna plans will generally cover services and procedures deemed “medically necessary” for treating patients with anorexia nervosa (AN) or bulimia nervosa (BN). [1] This generally covers therapies, medications, or procedures that are evidence-based and accepted by experts as valid treatments for those disorders. 

It’s possible that other aspects of Aetna’s insurance coverage can help with issues related to binge eating, substance use, or other mental health conditions that are closely related to many eating disorders.

Coverage varies by plan. To understand the full extent of what Aetna may or may not cover, you should review your healthcare policy or contact a representative for more specific information.

What Will Aetna Cover?

Aetna covers a variety of processes used to diagnose and treat eating disorders. Some assessments that are usually covered include: [1]

• Blood count and serum chemistry
• Bone density measurement 
• Electrocardiography
• Liver function tests
• Physical examinations
• Psychiatric or psychological consultation and testing
• Urinalysis

Once you or your loved one have received an official eating disorder diagnosis, Aetna may cover additional treatments, though the company prefers to endorse evidence-based procedures, as they’re more likely to result in successful treatment.

The specifics regarding which medications are covered and to what degree vary, although so long as a medication is FDA-approved for eating disorder treatment, it will generally be covered.

Aetna may also help cover treatments for co-occurring mental health issues, such as depression or anxiety, which may work to sustain eating disorders. These will likely be covered through the company’s mental health policies. You’ll have to examine your specific plan or contact a representative for more details.

What Will Aetna Not Cover?

Once again, the details of coverage depend on a case-by-case basis and are based on a number of specific details. But in general, Aetna will not cover treatments the company deems experimental and/or investigational or those it finds to have insufficient evidence based on peer-reviewed literature. 

Aetna also only specifically mentions anorexia nervosa and bulimia nervosa in its eating disorder coverage explanation. [1] It may be possible to have aspects of other eating disorders covered through their policies, but this will have to be handled on an individual basis.

Screening for eating disorders

One noteworthy aspect of treatment that the company generally does not cover is screening for eating disorders in adolescents and adults. Screening of otherwise asymptomatic individuals is generally considered “unnecessary.”

E-therapy

Also included on the company’s list of experimental and investigational treatments is e-therapy, where therapy is administered online via a mobile device app or website. [1] Yet, this decision has proven somewhat controversial, as some studies show telehealth to have an equal or better quality of care than in-person therapy. [2]

How to Start the Treatment Process Using Aetna

Starting the treatment process with an Aetna plan is a fairly standard process in most cases.

Securing an official eating disorder diagnosis is typically the first step in the process. This not only shows the insurance company that a medical professional has deemed the condition significant but helps them understand the types of treatment you or your loved one may need.

If there are any co-occurring issues, such as substance use, addiction, or conditions related to depression or anxiety, you may also want to have those issues diagnosed before seeking treatment. Aetna also provides coverage for these additional mental health concerns, with evidence-based treatments generally covered.

Taking this step upfront can be important, as some types of treatment can help address these co-occurring conditions simultaneously. And it’s generally recommended to treat eating disorders concurrently with any additional mental health concerns, as these related disorders are often so intertwined that they must be treated together in order to achieve progress on any front.

Once you’ve been officially diagnosed, you can begin looking at programs that can help or speak directly with an Aetna representative about treatment options.

Finding Treatment Centers in Aetna’s Network

Assuming you want to maximize your coverage, you should make sure to find a treatment provider in Aetna’s network.

Health insurance companies often operate within networks of known and trusted providers. An insurance company will utilize this list when determining which programs, treatments, or doctors they will or will not cover.

Finding Help for an Eating Disorder

If you or a loved one are dealing with an eating disorder, it’s important to seek help. These conditions are dangerous and could even be deadly if left untreated.

Contacting your insurance company is a good way to get started. You can also consult your doctor, therapist, or another trusted medical professional about any potential programs or best next steps.

If you feel uncomfortable with either of these options, you can anonymously contact a number of eating disorder hotlines, which can offer additional information and resources and point you in the direction of help.

Regardless, taking the time to look for programs is an important first step on the road to recovery.