Roadmap to Success
Full recovery is possible. However, maintaining positive outcomes is often a challenge. Individuals struggling with eating disorders often feel compelled to keep their symptoms as a coping mechanism in spite of all the chaos their disorder creates.
If you are considering residential treatment for yourself or a loved one, making a reasoned choice can be difficult leading to many questions and confusion. You may need help in finding your way in this process.
Some questions that you might have are:
- Where can I get help?
- What kind of treatment shold I be looking for?
- Where do I start?
We hope this road map acts as a guide through this process - we offer the following ideas and tips whether or not you select Avalon Hills as your program of choice. We have successfully helped hundreds of clients access care and understand the path to success and lasting recovery. It is our goal to help inform, educate and acknowledge the difficult truth about accessing quality and effective treatment.
Eating disorders are ego syntonic - meaning it is difficult for the person suffering to 'want' treatment. The advocate needs to research and decide on the program that fits best. The Practice Guidline for the Treatment of Patients with Eating Disorders: Third Edition serves as a helpful guid informing consumers of best practices & appropriate levels of care.
Usually a client is receiving care from a local treatment team (doctor, therapist, dietician, etc). The home team professionals likely have had patients who have received residential tratment and returned home to continue their recovery. These professionals will have valuable information regarding the success of these programs that may guide in your decision.
Since the roll-out of the Affordable Care Act, the residential treatment program landscape has drastically changed. Most treatment facilities originated with a desire to help those suffering from eating disorders. The founders may have had an altruistic focus on recovery and quality treatment. Nearly all US based programs are now owned by publicly traded corporations, private equity firms and venture capitalists. The founders are typically gone and the focus has shifted to shareholder profits. Much of the industry now treats to insurance coverage vs treating to successful outcome and this has created a revolving door of treatment. Short stays and discharges when coverage runs out are the norm. Quality treatment is markedly absent much of the time. It is important to know who owns and manages the program and their goals are - successful treatment or profits.
Generally people seeking treatment have insurance coverage, but self pay is also an option. If you plan to use insurance, it is vitally important to obtain a copy of your policy! Read the behavioral/mental health section carefully. Every insurance plan covers treatment differently for in and out of network services and it is crucial that you understand your covered services. Insurance plans vary in their compliance with federal and state mental health parity regulations. We reccomend comparing your mental health benefits with mental health parity regulations to ensure your plan complies. A good resource is Know Your Rights from paritytrack.org
If you are covered by a self-funded group plan, you may consider discussing treatment coverage and options with your HR department and CEO. They may be able to help the approval process move quicker.
Additionally, you may want to review the work from Kantor & Kantor, LLP at kantorlaw.net. They have developed a specialized legal practice representing clients whose claims for treatment of eating disorders have been unfairly denied by their health insurers or benefit plans.
Depending on what state you, your employer, and/or your insurance plan carrier is located, assistance can be received from the Insurance Commissioner, State Attorney General’s Office, or other government office that serves the purpose of consumer protection in health care insurance matters. It is important to file complaints because the number of complaints signals to officials that government intervention is needed. Many people also seek assistance from their elected state congressional leaders.
The admission department is the gateway to the program. They will be able to discuss your care and treatment options as well as help you get a feel of how they operate.
- Does the program specialize in the type of care I am needing? Do they treat any other issues that are occurring along with the eating disorder (anxiety, depression, PTSD, etc)?
- What is the treatment philosophy or mission of the program?
- How is the program different from other programs?
- What treatment components does the program offer?
- What are the average lengths of stay for their clients?
- Short lengths of stay may not address the severity of the disorder and are often not successful.
- How do they determine when a client is discharged?
- Is insurance accepted?
- Will admissions help me understand and navigate my insurance benefits and potential challenges?
- If my insurance is not accepted or they aren't contracted, what other coverage options can they discuss?
- Do they assist with single case agreements?
- Does the program treat to the minimum standards of care set forth by the American Psychiatric Association? The APA treatment guidelines can be found on psychiatryonline.org under The Practice Guideline for the Treatment of Patients with Eating Disorders: Third Edition. Table 8 starting on page 37 gives the level of care guidelines based on 10 criteria.
Once you have completed your program research, it is time to make a choice about admission. Eating disorder treatment can be difficult and taxing on both the client and families. With hard work and quality, compassionate care, it is our sincere belief that you will be able to find sustainable success, well-being and health.