Abstract

A major problem plaguing the discussion of insurance reimbursement for the treatment of anorexia nervosa is the apparent gap between research on variables associated with outcome and the formulas used for reimbursement. Outside of the mental health world, insurance coverage is driven by advanced analytics and actuarial data. However, in calculating insurance reimbursement for the treatment of anorexia nervosa, actuarial data associated with short-term and long-term outcomes are not utilized. Insurers typically focus on length of stay and daily rates in decision-making regarding preferred providers. However, it is possible to calculate the costs and effectiveness of treatment much more precisely by comparing treatment providers against benchmarks such as rate of weight gain and discharge body weight published in the literature. Providers should be encouraged to publish admission and discharge BMIs along with daily reimbursement rates to allow consumers and insurers to evaluate the cost effectiveness of treatment.

Authors and Affiliations