Health Plans and IROs Can Work Together to Determine Proper Care for Eating Disorders
Published June 8th, 2009
Eating disorders are a chronic mental health problem and affect up to 10 million females and 1 million males in the United States. Through access to clinical experts and state-of-the-art medical information, independent review organizations (IROs) provide a simple and lasting solution to decrease costs for patients with anorexia, bulimia, binge eating and laxative abuse. Additionally they deliver the appropriate standard of care, says NAIRO, a trade organization of IROs.
“The average cost of treating a patient with anorexia to health insurers exceeds $6,000 a year,” said Joyce Muller, president of NAIRO. “By identifying and providing the appropriate level of care initially, health plans can reduce the cost of managing these mental health problems.”
Treatment
In the United States, direct medical costs for treating patients with eating disorders falls on average between $5-6 billion a year. Underweight individuals with eating disorders who abuse laxatives, binge and purge face several medical risks. “Eating disorders require long-term counseling or psychotherapy linked with careful attention to medical and nutritional needs,” explains Dr. Barbara Center, Medical Director at Prest & Associates, Inc., an IRO providing psychiatry, addiction medicine and behavioral healthcare reviews. “Determining the level of care, its appropriateness and duration are best determined by an eating disorder specialist who understands the approaches various treatment centers take.”
Dangers
According to Dr. Center, eating disorders can cause severe damage to many organ systems, including serious cardiovascular symptoms. Identifying the appropriate level of care can prevent these problems that help push the cost of treatment higher. Incorrectly identifying and inappropriately denying service not only can lead to a patient’s death, but could result potentially in expensive litigation. Cutting-edge mental health experts from IROs offer a simple and effective solution for health plans to avoid such costly problems.
“IRO specialty reviews provide a mechanism to assure that enrollees are getting the appropriate level of care, when they need it and for the proper length of time,” said Muller.
About NAIRO
NAIRO works to promote the value and integrity of the independent medical review. Its members embrace an independent, evidence-based approach to medical review for resolving coverage disputes between enrollees and their health plans. For more information, visit www.nairo.org.
