Dear Insurance Company,
I wish you could see what I see. I wish you could know how much work it requires to motivate an adult living with an eating disorder to trust enough to agree to enter a program.
Everything is against their entering treatment—taking time off from work if their job will even allow it, getting coverage for their kids, telling people they know when their eating disorder is often their own secret, and enduring the shame of acknowledging that they are actually struggling with this disease—the shame of feeling that they ought to be over this by now. And the shame that comes with not fitting into society’s skewed perspective of what someone with an eating disorder looks like—because even those of normal weight and BMI can live silently with an eating disorder.
Image what it’s like to then have your patient dumped from program. Sound harsh? Well that’s how it feels, both to them and to us as their providers. A mere 2 weeks in a residential program (following years living with their disorder) and they’re required to step down, told they don’t need to stay there any longer, that it will no longer be covered. And the patient? She is not happy at all. That very reluctant patient is finally finding her voice and stating loud and clear that she desperately needs to remain there. Her ED thoughts are so loud that the controlled environment of resi is the only thing that is resulting in the positive outcomes observed at program. So she is discharged because she has done well.
The premature move to partial day program, PHP sets her up for failure. And because her behaviors return, she is again discharged. Yes, now released because she’s not doing well enough, without a plan to move her to the more appropriate higher level of care. Can you see the absurdity?
Some numbers matter
We certainly do need to look at numbers—but not necessarily the ones that insurers like you are assessing. Weight may tell less than most other measures. Believe it or not, a weight may be completely in the normal BMI range (or even high) and an individual may be struggling with an eating disorder. This is anything but rare, I’ll tell you. And weight may change little as eating increases significantly as metabolic rate increases in patients with anorexia. Patterns of restrictive eating followed by binging and even purging may have little impact on weight, or may support weight gain. So focusing on this number is truly misdirected.
These numbers matter
How about the EDE-Q score which assesses eating behaviors and disordered thoughts? It’s a quantitative test to measure change in recovery. Pulse, particularly lying, sitting and standing—that’s a number worth assessing. And self- reported number of skipped meals? Or frequency of purges? Or binges? Or number of hours or compulsive exercise? And of course there’s caloric intake relative to need. These are numbers that may tell you something about a patient. These numbers are worth counting.
I realize there are not unlimited funds for care. But perhaps listening to the professionals who can really assess their eating disorder patients—aside from relying on simple weight and BMI—might save you more money in the long run. You’ll collect no premiums from our patients who lose their eating disorder battle.