Eating disorder clinic again taking Wellmark patients

July 23--A Minnesota-based eating disorder treatment center once again is accepting patients insured by Wellmark Blue Cross Blue Shield, but with caution.

BACKGROUND

The Emily Program in Minneapolis serves about 6,000 patients annually through intensive outpatient and residential treatment programs. Last fall, TEP stopped accepting Wellmark beneficiaries after continued billing issues, said Jillian Lampert, chief strategy officer for the center.

Intensive treatment is expensive, so TEP requires patients to pre-authorize coverage of their treatment with their insurer, and TEP had worked with Wellmark beneficiaries in the past. "In June of 2015, something seemed to change," Lampert said. "We don't know what it was.

Eating disorder treatment coverage has always been difficult to obtain from insurers, but Lampert said TEP was seeing patients with pre-authorized coverage later be denied coverage after completing treatment at TEP.

Wellmark spokeswoman Teresa Roof said Wellmark sometimes sees requests for reimbursement from a medical provider that does not match what the patient's records show is medically necessary.

However, some patients experienced denials a Minnesota lawyer involved with some of their cases said she had never seen before. One of those was Mindy Pfab of Cedar Rapids.

Pfab pre-authorized for care, but later found out she was denied coverage and was on the hook for tens of thousands of dollars. Shen she contested the claim, Wellmark offered to pay for some of her care.

WHAT'S HAPPENED SINCE

Two of about four TEP patients' cases involving disputes with Wellmark had "a successful resolution," though another case was denied, Lampert said.

"We're hopeful that this problem has been remedied by Wellmark," Lampert said.

She also said she knows the Eating Recovery Center in Denver, Colo. also experienced billing issues with Wellmark in the last year.

TEP is accepting Wellmark beneficiaries again, but the center is cautioning patients before they enter treatment.

"We say something like, 'it's important for you to be aware that we have had these problems with Wellmark. Most families have been able to work through those denials, but it's taken significant time and energy to work through those cases,'" Lampert said.

Lampert said they're asking Wellmark beneficiaries to:

l Call for pre-authorization and ask for a case manager right away

l Request a full copy of the insurance plan

l Have and document the conversation with the insurance provider about pre-authorization

"We underscore that conversation with Wellmark, it's so crucial," Lampert said. "We don't want them to experience financial hardship."

l Comments: (319) 368-8516; makayla.tendall@thegazette.com

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