- Calls to this hotline are currently being directed to Within Health or Eating Disorder Solutions
- Representatives are standing by 24/7 to help answer your questions
- All calls are confidential and HIPAA compliant
- There is no obligation or cost to call
- Eating Disorder Hope does not receive any commissions or fees dependent upon which provider you select
- Additional treatment providers are located on our directory or samhsa.gov
Emblem Health Eating Disorder Coverage
If you’re suffering from an eating disorder, it’s crucial to find treatment. However, before enrolling in a treatment program, you need to understand your health insurance policy.
While some health care plans cover certain aspects of eating disorder treatment, other plans don’t. And different treatment programs and centers also accept different types of insurance.
In this article, we’ll discuss the eating disorder coverage provided by Emblem Health, and show you how to find treatment centers that work with this provider.
Does Emblem Health Cover Eating Disorder Treatment?
When it comes to treatment, Emblem eating disorder coverage is available for specific in-network programs. When researching treatment centers, make sure they accept Emblem. This way, you can receive coverage and avoid costly out-of-pocket expenses for treatment.
What Will Emblem Health Cover?
Through the Emblem plan called ValueOptions, partial coverage is available at in-network outpatient programs.
Some types of covered treatments include: [1]
- Pharmacotherapy, or treatment provided through medication
- Nutritional rehabilitation
- Family therapy
- Psychosocial intervention, including different types of talk therapy and education
Emblem Health will cover up to 60 outpatient treatment sessions per year. However, if your treatment plan requires additional visits, you’ll need to pay for them out of pocket.
There is also possible coverage for co-occurring conditions, including alcohol or substance abuse, if you receive a dual diagnosis.
Additional coverage depends on your specific insurance policy. If you’re unsure about treatment coverage, call an Emblem Health representative.
What does Emblem Health Not Cover?
Emblem eating disorder coverage isn’t available for most inpatient treatments. If you need inpatient treatment, you’ll have to call your policy representative for approval.
Emblem also doesn’t usually cover specialty treatment programs or facilities. These rehab centers generally have more exclusive or luxurious amenities and activities.
Specialty treatment coverage is available on a case-by-case basis. Start by giving Emblem a call to determine if your policy will cover your specific case.
How to Start the Treatment Process Using Emblem Health
Getting started with the treatment process using Emblem Health is simpler than you think! These four steps will help you begin your journey toward eating disorder recovery:
- Find a program you like. First, you should determine which treatment program would be most effective for your symptoms. Find an in-network treatment center that suits your needs, including location, philosophy, accreditation, and environment.
- Contact Emblem Health. You’ll need to discuss coverage details. Be sure to provide them with as much information as possible, like your desired treatment center and program, to finalize everything. This step will also determine if there’s a copay or self-pay for any part of the treatment.
- Contact the rehab center. At this point, you’ll complete the required application and enrollment process. The facility will then verify your coverage through Emblem Health.
- Start treatment. Once your insurance is verified, the treatment center should contact you with more details. You may also want to coordinate with your designated provider to determine your treatment schedule and other requirements, especially for a residential or PHP program.
Types of Eating Disorder Treatment Programs
While researching your healthcare options for eating disorder treatment, you may also want to look into the different levels of care available. These different levels represent a different intensity of treatment. Which level is best for you depends on the severity of your symptoms.
The extent of Emblem eating disorder coverage depends on your policy. Your plan may not cover treatments offered at all of these levels, so make sure to discuss your options with an Emblem representative before moving forward with a specific program.
Residential/Inpatient Treatment
Residential and inpatient treatment programs are for individuals with severe eating disorder symptoms. They offer the highest level of care, including 24/7 monitoring to help manage unhealthy behaviors. The clinical residences provide a supportive environment conducive to eating disorder recovery.
Patients are often considered unstable in some way. Instability might include deteriorating health or co-occurring medical conditions. Depending on your specific policy, Emblem Health may cover inpatient treatment. Talk to a representative to determine if your desired program is approved.
Partial Hospitalization Programs (PHP)
Partial hospitalization programs (PHP) offer less intensive treatment than residential programs. While they don’t need hospitalization, patients receive constant monitoring. Sessions are between 6-8 hours and allow patients to sleep at home instead of the facility. In this case, instability is less severe than in patients that need higher level care.
While PHP eating disorder treatment coverage isn’t specified, you can still get in contact with Emblem Health to verify.
Outpatient & Intensive Outpatient Programs (IOP)
Outpatient programs are most effective if you have manageable eating disorder symptoms. This lower level of care doesn’t require hospitalization or constant monitoring. They also offer the most flexibility. Patients maintain their daily routine while still receiving treatment. Five days a week, morning, afternoon, and evening sessions are available.
As mentioned above, Emblem Health covers 60 outpatient sessions per year. If you’re unsure about the length of your treatment, clarify the total sessions with your treatment center.
Virtual Treatment
If your desired treatment center is in a different state, consider a virtual program. In most programs, IOP and PHP treatments are available. This option is ideal if your eating disorder symptoms are manageable and less severe.
Treatment is often structured the same way as in-person sessions. The main difference? You’ll attend treatment via video chat. Make sure you have access to a computer and an internet connection.
There may be additional stipulations with Emblem virtual treatment coverage. Don’t be afraid to ask your representative questions to clarify the limitations of your policy when it comes to eating disorder treatment coverage. The most important thing is that you’re able to begin your journey to recovery.
Treatment Centers Accepting Emblem Health
Health insurance is a continually changing industry, and partnerships between providers and treatment centers are likely to change over time.
Aside from reaching out to your provider for advice on programs that may accept your healthcare policy, you can search online for the most up-to-date information.
Regardless of where you look, it’s important to seek out help for an eating disorder. These conditions can be dangerous or even deadly if left untreated.
Start by discussing your condition with your primary care provider. Your doctor can assess the severity of your symptoms and suggest the next steps, including which treatment program would work best.
But remember that help is always available, and can help you get back on track toward a healthier life.
Resources
1. Provider Manual: Chapter 26: Behavioral Health Services. Emblem Health. Accessed January 2023.
Published on May 12, 2023 Published on EatingDisorderHope.com
