Victor M. Fornari, Martin Fisher
CaseRepClinPractRev 2005; 6:1-4
Available online: 2005-01-02
Background: Receiving the appropriate insurance payment for the inpatient care required in the treatment of anorexia nervosa has become more difficult and complex with the advent of managed
health care during the past fifteen years. The appeals process highlights the importance of advocacy for what is in the patient’s best interest.
Case report: In this paper, we describe the successful appeal following insurance benefits denial for an eleven–year old boy with anorexia nervosa. It is the physician’s responsibility to diagnose and
formulate a treatment plan. Advocating for third party reimbursement, in order to provide the care that is medically necessary, is now an essential component of the health care provider’s obligation.
Conclusions: External appeal to state authorities is an additional alternative for dealing with insurance benefits denial for patients with anorexia nervosa.
Keywords: insurance benefits denial, external appeal, advocacy