Using Texas Children’s Health Plan for Eating Disorder Treatment

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Texas Children’s Health Plan, founded by Texas Children’s Hospital in 1996, was the first HMO created just for children. Coverage is offered through both CHIP and STAR Medicaid. The plan also offers coverage to adults and pregnant women through several different options. Although each plan is a little different, the following guidelines will lead you through the process of getting coverage for treatment of an eating disorder.

Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, are characterized by a dysfunctional relationship with food and an extreme preoccupation with food and weight. Over 24 million people in the United States have at some point in their lives suffered from an eating disorder, but only 1 in 10 will receive treatment. An eating disorder can take over your life and damage you physically and emotionally.

Eating disorders are a serious problem that can lead to long-term damage to your heart or kidneys, or in severe cases, even lead to death. Getting help early is paramount in recovering from this life-altering disorder; so if you or one of your children is currently struggling with an eating disorder, call us today at . We are available 24/7 to get you started on the road to a healthier life.

Texas Children’s Health Plan Coverage for Eating Disorder Treatment

If you are using Texas Children’s Health Plan for eating disorder treatment, there are some things you need to know. Although you do not need a referral from your child’s primary care physician, you do need to find a provider that is included in the Texas Children’s Health Plan provider network. The company has a behavioral health and substance abuse hotline that you can reach toll-free at 1 . This hotline is open 24 hours a day, seven days a week and will help you find a provider. The hotline is staffed by both English- and Spanish-speaking representatives and can find an interpreter for other languages if needed.

If it is an emergency, you can go directly to the nearest emergency room, call 911, or call the hotline to make sure you receive the care you need right away.

Will Texas Children’s Health Plan Cover Eating Disorder Treatment?

The Texas Children’s Health Plan eating disorder coverage includes all treatments that it deems medically necessary. These treatments must be furnished in the least restrictive setting possible and at the most appropriate and safe levels. This means that although some treatment may be covered, not all levels of care will be. When planning out the best course of treatment, remember to check with your insurance provider to see what is covered.

Managing an eating disorder requires long-term care and planning. Eating disorder treatment usually requires a multidisciplinary approach and may include any or all of the following medical professionals:

• A primary care doctor or other medical doctor. An eating disorder can take a harsh toll on your body, and a medical doctor will treat and manage any health concerns during and after the initial treatment.
• A psychiatrist. This licensed physician specializes in providing therapy and managing psychoactive medications, when necessary.
• A psychologist. A psychologist specializes in providing counseling and therapy, which is essential to overcoming an eating disorder.
• A dietician. A dietician can provide nutritional counseling and formulate meal plans to help you transition to a healthy and appropriate diet.
• A social worker. A social worker can be valuable in coordinating treatment and helping you sort through your options.

How Much Will Eating Disorder Treatment Cost?

When you are considering getting eating disorder treatment, the question of cost is an important consideration. Treatment can be expensive, and not all forms of treatment are covered by the Texas Children’s Health Plan. Treatment for an eating disorder is tailored to the patient’s needs and can include any or all of the following:

• Psychotherapy or counseling. Therapy is essential in treating an eating disorder. Therapy will help you to learn healthy ways to deal with stressful situations, monitor your eating habits and develop better problem-solving behaviors.
• Family therapy. This type of therapy is often used for children and teenagers with eating disorders. The goal is to get the entire family involved in the patient’s care.
• Weight restoration. If the patient is extremely underweight or overweight, one of the first goals of treatment is to restore a healthy weight. This is generally done in a medically supervised manner.
• Nutritional education. Eating disorders involve an unhealthy relationship with food, and nutritional counseling and education are needed to plan appropriate meals and to instill eating habits that are essential to maintaining an ideal weight.
• Medication. Although there is no medication that will cure an eating disorder, medications are sometimes prescribed to control urges and manage anxiety. Medications are also useful in treating depression and anxiety disorders, which are often seen in patients with eating disorders.

The cost of treatment for an eating disorder can vary widely depending on the severity of the disorder, the condition of the patient and the recommended course of treatment. The average residential program costs $30,000 a month, and patients may need a stay of up three months or more. Be sure to stay in contact with your insurance company while exploring your treatment options and fully understand what is and is not covered.

Even when your treatment is covered by insurance, copayments may be necessary. Check with Texas Children’s Health Plan to see if you will be responsible for any copayments.

Inpatient Eating Disorder Treatment vs. Outpatient Services

The goals of eating disorder treatment are to stabilize the patient; stop any destructive behaviors, such as binge eating, purging and restricting; instill healthy eating behaviors; normalize weight; and treat any coexisting mental health issues that may be triggering or worsening the eating disorder. Each patient should be fully evaluated to determine the severity and extent of the disorder before devising a treatment plan.

Patients may need to be hospitalized initially if they are not medically stable. Complications of an eating disorder include irregular heart rhythms, electrolyte imbalances, dehydration and kidney and cardiac damage. These issues need to be dealt with and resolved immediately, because they can be life-threatening.

Ongoing care, once the patient is stable, can be delivered at an inpatient or outpatient facility. Often, treatment plans include both. The most severe patients generally start out at an inpatient facility and move on to an outpatient regime after 30, 60 or 90 days. Some patients only require outpatient treatment. Your doctor should review all your options with you or your loved one and help you to choose the best course of treatment for your personal circumstances. Some factors that go into selecting the duration and intensity of treatment include:

• Mental health status. Each course of treatment should be tailored to fit the patient’s specific status and needs.
• Duration of the disorder. The earlier treatment is sought, the easier it is to treat, generally. Eating disorders that have a long duration may be more resistant to treatment and may need more intensive treatment.
• Coexisting disorders. Successful treatment of an eating disorder requires that any other mental disorders the patient might have be addressed. Illnesses such as depression and anxiety disorder often trigger and worsen the urges and behaviors associated with eating disorders.
• Insurance limits and ability to pay. Be upfront with your doctors about what treatments you can afford. Contact your insurance company for help with treatment options.

Dual Diagnosis Eating Disorder Therapy

Often, patients with an eating disorder present with other coexisting disorders. In order to successfully treat the eating disorder and maintain a healthy lifestyle, the other issues that may be the root of the eating disorder must be treated and resolved. The relationship between the eating disorder and other disorders may be complicated, so one of the goals of treatment should be to explore and resolve these other disorders. Some of the most common coexisting conditions are as follows:

• Depression. Depression is a mood disorder characterized by intense sadness, guilt or worthlessness. Symptoms can include alterations in sleeping and eating habits, low energy levels and feeling of self-hate.
• Substance abuse. Substance abuse issues, whether with alcohol or drugs, are commonly seen in conjunction with eating disorders.
• Anxiety disorders. Anxiety disorders include panic disorder, post-traumatic stress disorder, generalized anxiety disorder and social anxiety disorder. An eating disorder may develop in an attempt to deal with the symptoms.
• Obsessive-compulsive disorder. This is a type of anxiety disorder characterized by repeated and obsessive thoughts or actions. Because many patients suffer from obsessive thoughts and rituals toward food, these disorders are strongly connected.
• Self-mutilation. Patients with an eating disorder often struggle with self-injury.

Sometimes patients can feel overwhelmed by an eating disorder, but getting treatment is the first step toward a healthy life. If you or one of your children is currently suffering from an eating disorder, our representatives are standing by 24/7 to help you. Call today to explore on how to find help in treating an eating disorder.

Insurance vs. Private Pay for Eating Disorder Options

After you have been evaluated, it will be time to look at treatment options and decide how you are going to pay for the various treatment possibilities. Have a clear view of what your insurance will pay for, and if that is not sufficient, you still have other possibilities.

If you have the means to pay for treatment, you have many options, from luxurious treatment facilities to long-term intensive programs. If you don’t have the means to pay and your insurance plan won’t cover the extent of treatment you need, there are still options. Some treatment programs will take patients through a scholarship program, and others will charge based on a sliding scale, depending on your income. Other treatment facilities offer payment plans or financial aid for families that meet certain criteria. Contact the treatment center to discuss your options. Some forms of treatment are relatively low-cost, so speak with your doctor about adapting your treatment plan to your financial needs.

An eating disorder can be both physically and mentally draining. Remember that recovery is possible, and that early intervention is crucial to successful treatment. One study found that 76 percent of adolescents suffering from anorexia recovered completely within 10 to 15 years. If you or your child is struggling with any kind of an eating disorder, call us now at 5 for help finding treatment options and navigating coverage through your Texas Children’s Health Plan.