APS Healthcare Coverage for Bulimia Treatment 

As such, most people looking for eating disorder treatment must take insurance coverage into account. And that process can be difficult in its own way.

If you or a loved one use APS Healthcare as your insurance company, there are some things to keep in mind about the type of mental health benefits and eating disorder coverage the company offers for bulimia nervosa and other types of eating disorders.

What Is APS Healthcare?

APS Healthcare is a managed behavioral health organization (MBHO), and the leading provider of mental health services in Puerto Rico.

Started in 1999, the company has grown to provide coverage for 1.6 million people, working with more than 1,000 mental health professionals at 16 community-based clinics throughout the island. [1]

APS takes a holistic approach to mental health care and offers programs for children, adolescents, and adults dealing with a range of conditions, including eating disorders.

Does APS Healthcare Cover Eating Disorder Treatment?

In a word: Yes. APS Healthcare plans generally provide coverage for eating disorder treatments. Though, as with nearly all health insurance providers, there are usually stipulations involved.

Evidence-based outpatient treatments are the most likely to be covered, so long as you have an official eating disorder diagnosis. Treatments may also need to be recommended by a medical professional in order to be approved. 

Inpatient treatment coverage can be more complex to get covered, though if a medical professional feels it is medically necessary in order for you to recover, this type of care is more likely to be approved. If your request for coverage is initially denied, you can appeal that denial and have the claim reconsidered. 

What Will APS Healthcare Cover?

The specifics of what APS Healthcare will cover depend entirely on the details of your insurance policy. You should refer to your policy or contact APS for further information on your particular situation.

That said, like most insurance companies, APS is most likely to cover evidence-based treatments, or those considered backed by a sufficient level of scientific studies.

The company will likely also only cover treatments it considered medically necessary. And outpatient treatment, where a patient lives at home and commutes to treatment centers, will likely be easier to secure coverage for compared to inpatient programs, where a patient lives full-time at a treatment facility.

If you’ve received a dual diagnosis for an eating disorder and co-occurring mental health condition, such as depression or anxiety, it’s possible that your plan may also cover additional evidence-based tests and treatments for the second condition.

What Will APS Healthcare Not Cover?

A treatment must generally be considered medically necessary and backed by current medical evidence in order to be covered by insurance. Treatments considered experimental, or those with limited evidence supporting their use for the treatment of eating disorders, are far less likely to be covered.

For example, diagnostic tests for a patient with no eating disorder symptoms may be considered unnecessary, and treatments involving cannabinoids may be considered unproven or ineffective.

APS Healthcare might also opt to not cover a particular treatment if a less expensive but equally-effective alternative is available. And plans may also only partially cover treatment, including only covering a certain number of days at an inpatient facility.

Once again, you’ll have to consult with your specific policy for more details of what your plan will and will not cover.

How to Start the Treatment Process Using APS Healthcare

Once you’re ready to seek treatment for your eating disorder, the process should begin with an in-network mental health professional, who will have to give you an official diagnosis of your condition. This will allow you to get coverage for related treatments, which you should also ideally receive from in-network providers. 

Similarly, make sure to get a diagnosis for any other co-occurring mental or physical health issues you may have, especially if they may change the ideal approach to treating your eating disorder. For example, substance use disorder commonly co-occurs with eating disorders, and this dual diagnosis may significantly change what a person’s ideal treatment plan looks like. [2]

Once you have an official diagnosis, you can begin looking for programs that will help treat your condition(s). After you find a program you like and want to enroll in, it’s imperative to ensure they take your particular insurance policy. You may want to call the center directly or consult with an APS representative to ensure your treatment will be covered.

At that point, you’ll have to submit insurance details to the program, and they will most likely correspond directly with APS to finalize the approval process.

Finding Treatment Centers in APS Healthcare’s Network

Searching for eating disorder treatment programs in APS Healthcare’s network is a great way to help ensure any programs you find will be covered, avoiding any frustration or disappointment down the road.

Learn about the in-network treatment options in your area or by searching for options individually online.

But even if you found your treatment option through the company’s website, it’s best to double-check with the program specifically that they accept APS Healthcare insurance, as websites or online databases may not represent the most up-to-date information.

Dealing with the intricacies of health insurance can be a difficult process, but once your coverage has been confirmed, you can start the enrollment process and take another well-earned step on the road to recovery.