Full recovery from Anorexia Nervosa is very painful, if even attempted. Our recovery industry in this country is dropping the ball for many reasons, but the overarching issue, is that they are following standards that insurance companies will pay for. If these standards worked, we wouldn’t have the recidivism rates we do. The numbers don’t lie, and there is nothing to challenge the current approach to treating this massively complex disease, because insurance will not pay for it. I was able to build a 10+ year clinic with less than 6% recidivism rate BASED on everything I knew wasn’t happening in traditional treatment. What a shock that the gold standards of eating disorder treatment which I was not following correlated to a T with how much insurance would pay.
The way private insurance actually works, and the way they make money is by charging their members monthly premiums, and then only paying out what they think will cost them the least. For instance a $25 gym membership seems like an inexpensive way to prevent heart disease, but over the course of 40 years this comes out to be $12,000. To resuscitate a heart attack (2019) comes to an average of $1,958.90 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746039/). The math becomes really easy to understand how eating disorder treatment standards could easily come down in order to circumnavigate insurance payouts. Scary thought.
So the real cost to treat the medical complications of Anorexia Nervosa, which is still deemed a mental illness is astronomical. If we place the highest mortality rate on a mental illness, year after year it comes out to be Anorexia Nervosa (https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2012/spotlight-on-eating-disorders.shtml).
The reasoning for the high death rate in this mental illness is mostly due to MEDICAL issues that stem from the disorder, metabolic collapse, and starvation. But treatment is only paid for by the mental health side of an insurance plan, unless they need medical resuscitation for a heart attack, again, an easy $1,958.90. This is more than fully covered in order to avoid the cost of inpatient treatment. The average cost in 2015 was $54,932 per admission and a mean length of stay of 37.9 days (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565171/).
This comes out to be $1,449.39 per patient per DAY! When anorexic patients needed more treatment than 37.9 days, as the usual length for full recovery at our clinic was 1-year, the insurance companies would cut off payments, because, at this rate it would cost the insurance companies $529,028.50 per patient, and that’s FIVE years ago. I understand how traditional treatment HAD to adopt to insurance payment standards in order to continue getting paid. It’s not greedy, it’s what it costs. You would find families mortgaging their homes in order to pay for adequate treatment time for their child.
Caught between a rock and a hard place at my clinic, once insurance ran out, we ended up paying for our patients, until we closed because we could no longer afford to be open. There was NO way I was going to let someone just relapse because their insurance ran out. Our best outcomes were the people who spent an average of one year with us, and it had to be THEIR recovery, not our “program.” Our patients made their OWN recovery plan, and we supported them in executing it. The results were astonishing. People got better. Yes, we had to pay out of our own pockets to keep this ship running, but I was going to do that until we ran out of money. So we closed once we couldn’t support the clinic any longer.
Had we followed traditional standards of treatment, I KNEW we would just be contributing to the problem, just to get reimbursement for suboptimal care. I don’t blame treatment centers for giving all the care they’re allowed to but remaining not enough, because they actually can’t afford to, whereas I was audited because they were paying and I was getting better results. Good results are expensive, I get it, but insurance companies don’t make money with prevention, or adequate treatment. They make money by doing the minimum treatment, denying claims, and collecting premiums. If our treatment and industry standards continue to circumnavigate the globe of insurance payouts, we will continue to see full relapse rates of 35 – 41% when released from inpatient treatment on the schedule of the insurance companies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017136/
What people with Anorexia Nervosa need in treatment is time (and autonomy, but we’ll talk about that later), and right now it’s too expensive.
I’d love your insights on this if you’re willing to share your stories.*If you need support NOW, feel free to reach out to me!*
Email Scarlett:
SRO@ScarlettRameyOfficial.com
Text Scarlett:
(206) 910-8690
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Scarlett Ramey, MS, RDN, CD
P.S. Hope to see you in the comments. Let’s rally together during this time and stay connected in supporting YOUR Recovery journey. The world deserves the BEST of you.♥️