AmeriHealth Coverage for Bulimia Treatment 

Programs can be lengthy and, unfortunately, are generally also expensive. So on top of facing the difficulties of navigating an eating disorder, many people must simultaneously work their way through any additional requests, requirements, or rules issued by their health insurance provider in order to secure coverage for treatment.

If your health maintenance organization is AmeriHealth, you may be wondering about the details of AmeriHealth bulimia treatment. And in fact, there are some important things to know about AmeriHealth insurance when it comes to eating disorder coverage.

What Is AmeriHealth Coverage?

AmeriHealth is different from many health insurance companies. Rather than one organization with a number of plans on offer, AmeriHealth is actually comprised of a family of companies.

Together, this patchwork of insurance options covers nearly the entire nation, with a variety of coverage types on offer, from locally-focused plans for individuals to nationally scaled insurance options for employers.

As such, specific coverage for bulimia nervosa (BN) depends on a number of different factors. Still, AmeriHealth plans should generally cover evidence-based treatment for BN and other eating disorders.

Does AmeriHealth Cover Eating Disorder Treatment?

Yes, AmeriHealth plans will generally cover eating disorder treatment through their behavioral health services, though there are several stipulations that usually apply.

Like many insurance companies, AmeriHealth typically only covers evidence-based treatments and tests or those that have been backed by scientific studies and data. This means more experimental or cutting-edge modalities for eating disorder treatment are usually not covered or will require explicit permission from the insurance company, as well as a specific recommendation from a primary care physician or specialist.

Outpatient eating disorder treatment, where a patient lives at home and commutes to treatment, is also much more likely to be covered or to be covered more extensively than an inpatient program, where a patient lives full-time at a treatment facility. Some plans may require a patient to try outpatient therapy before they will cover any costs incurred by inpatient programs.

With this said, you will generally need to use an in-network treatment provider to receive the best level of coverage. How much coverage your plan may or may not provide for out-of-network care will depend on its specifics. You should contact a representative from your insurance company for more specific details of your plan.

What Will AmeriHealth Cover?

AmeriHealth plans cover most evidence-based outpatient eating disorder treatments. [1]

It’s also possible to apply for inpatient treatment coverage through Magellan Health Services, which oversees AmeriHealth’s behavioral health services program, although the approval process for those programs is typically more complex than that for outpatient services. [2]

Inpatient care generally requires prior authorization from a preferred provider organization. You will likely have to secure an official recommendation for the specific type of treatment program you’re looking into and provide a recommended length of time of treatment. Your AmeriHealth provider will then have to approve of this treatment plan before you can get that care covered.

Some AmeriHealth plans may also cover evidence-based treatments for co-occurring mental health issues, such as depression and substance use disorder (SUD), if you receive a dual diagnosis.

What Will AmeriHealth Not Cover?

As is true of most insurance providers, AmeriHealth providers only cover what they deem to be necessary or effective treatment. This means they will generally not cover treatments deemed unnecessary or not backed by available medical evidence.

For example, eating disorder screenings for asymptomatic individuals may be considered unnecessary, and acupuncture as a treatment option may be considered unproven or ineffective. And the company will most likely stick to this policy, even if your primary care physician or another medical professional recommends these courses of care.

It’s also possible that the inpatient treatment provider you prefer will not be covered by your insurance provider. As a general rule, inpatient programs for eating disorders tend to be the hardest legitimate treatment option to get approved, as these programs tend to be substantially more expensive than other forms of care. 

Your options will also depend on whether your AmeriHealth policy is an HMO or PPO. HMO plans generally have much more limited in-network options, while PPO plans incorporate more expansive networks of doctors and care centers.

How to Start the Treatment Process Using AmeriHealth

Once you acknowledge that you may have bulimia nervosa or another eating disorder and want to be treated, your first goal should be to get a diagnosis, as that will normally be required to get relevant treatments approved.

You may need to have this diagnosis come from an in-network or otherwise approved doctor in order to be accepted by the insurance company. Make sure to check your specific plan for more details.

If you need a treatment that is not normally approved, the doctor recommending that treatment will need to submit evidence that it is necessary to your insurance provider. At that point, your provider can decide whether they accept the submitted evidence and explanation or will stick to their refusal of coverage.

Finding Treatment Centers in AmeriHealth’s Network

The AmeriHealth family of companies has a rather large network of providers you can choose from. Using this link, you can begin to search for in-network treatment providers in your area. [3] 

When you find treatment providers that seem able to meet your needs, you can then research them and check reviews of their services. Look for any past controversies or legal troubles, as this is a good standard practice before using the services of any health treatment provider.

As an extra measure of caution, you may also want to call the provider to double-check that they accept AmeriHealth insurance, as partnerships are liable to change, and online databases may not represent the most recent or accurate options.

Working with an insurance company to secure eating disorder coverage can be a frustrating and difficult process, but the type of treatment it can help provide for those in need—and the opportunity to work toward recovery from these debilitating conditions—can make the entire thing worth it.