What is the Coverage for Eating Disorders in Health Insurance?

Understanding Health Insurance for Eating Disorders in India

Eating disorders affect millions of Indians yearly, yet healthcare providers in India fail to grasp the problem, with patients having limited insurance coverage for their complex needs. New policies across the industry have improved coverage for such needs. Still, patients often struggle to access treatment due to a lack of specialists and high deductibles on their health insurance.

Patients in crisis should not encounter extra obstacles when exploring different recovery options. Read ahead to understand the eating disorder insurance policies in India so you can advocate effectively for proper treatment benefits.

What Should Your Health Insurance Cover for Eating Disorders?

The Mental Healthcare Act of 2017 has established a legal requirement for Indian insurers to provide mental health coverage, including eating disorder treatments. Policy coverage for treatments varies widely.

Thus, patients must understand the treatments their insurance should cover, including:

• Coverage for Specialist Evaluation: Coverage for evaluations by specialists should consist of qualified professionals conducting assessments at institutions such as NIMHANS and accredited private mental health facilities.

Aftercare services for anorexia nervosa, bulimia nervosa, binge eating disorder and ARFID must be covered by insurance policies since these conditions are persistent in urban Indian youth.

• Disease-based Coverage: Severe anorexia and bulimia patients requiring medical stabilisation treatment should receive hospital care at multispecialty facilities, which must be included under emergency care coverage.
• Therapy Coverage: Medical organisations should provide outpatient therapy sessions at hospitals and private clinics. Health insurance must provide coverage for evidence-based psychotherapy treatments, such as CBT-E and family-based treatment, despite their limited availability among practitioners in various areas.

At Star Health, we offer coverage for outpatient sessions and treatments under our Star Outpatient Care Insurance Policy. We also provide hassle-free claim settlements with less turnaround time across 14,000+ network hospitals in India.

• Coverage for Nutritional Support: Health insurance plans must include nutritional support from dietitians who specialise in eating disorders, alongside psychiatric care.

Navigating Insurance Denials: Rights and Appeals for Eating Disorder Patients

Indian patients with eating disorders face widespread insurance rejections even though the Mental Healthcare Act protects their care. Insurance policies cannot deny mental health coverage under the provisions of the Mental Health Care Act 2017 and must treat mental health treatment equally.

Here are the things to keep in mind if you face denial from your insurer:

• Your first step is to request an explicit written explanation from the insurer that outlines the specific policy terms applicable to your case.
• Insurers' main reasons for denying coverage are the lack of medical necessity or pre-existing condition exclusions, inadequate documentation, and provider network restrictions.
• The fundamental reason behind insurance denials emerges from their poor recognition of eating disorders as true medical disorders.
• Seek protection through expert medical records, including exact ICD-10 classifications and record evidence of resulting physical consequences.
• Submit an internal request to your insurer within the designated timeframe, typically 30 days from the date of denial.
• Include all necessary medical documentation referencing particular provisions in the Mental Healthcare Act while submitting.
• After an unsuccessful internal appeal, your other options are the Insurance Regulatory and Development Authority of India (IRDAI) and the Regional Insurance Ombudsman.
• Success in obtaining claim approval requires persistence because many denied cases eventually win in their follow-up appeals to the insurance company.
• Patient advocacy organisations, along with detailed communication records, should be maintained during the appeal process against insurance denials for eating disorders.
   

How to Compare Insurance Plans to Get the Best Coverage Options for Eating Disorders?

Health insurance selection in India requires attention to particular features that determine the coverage level available for treating eating disorders.

Here are a few things to keep in mind while you’re comparing the plans:

• Larger companies often offer more comprehensive benefits than employee-based group insurance plans.
• Select the plan which explicitly states psychiatric coverage, since it demonstrates the probability of supporting eating disorder therapies.
• When choosing the plan, focus on extended hospitalisation time and increased mental health sublimits with criteria for outpatient therapy access.
• Patient advocacy groups and online forums serve as vital sources of information about insurer actions regarding eating disorder claims in the Indian market.
   

Seeking proper insurance coverage for eating disorders in India presents challenging obstacles. However, it is gaining awareness due to the inclusive insurance options that can eventually lead to complete healthcare services. After all, financial costs should not block you from accessing the medical care that will help you get better.

Also Read:

→ What is Health Insurance for Huntington's Disease

→ What is Health Insurance For Schizophrenia Treatments

→ What is Health Insurance for Anxiety Disorders

→ What is the Coverage for Bipolar Disorder in Health Insurance

→ What Happens When You Miss an EMI for Health Insurance