Perhaps the most important reason to welcome the inclusion of binge-eating disorder in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is that it will, in most cases, ensure coverage for the disorder.

While insurance companies have generally shown flexibility and understanding in providing coverage for binge-eating disorder, its inclusion in DSM-5 gives the disorder legitimacy and accepted criteria.  In most cases, there will no longer be any question of coverage.

Until now, individuals with binge-eating disorder were typically diagnosed as having EDNOS, which stands for “eating disorders not otherwise specified.”  Failure to meet medical criteria for a disorder puts coverage in question and may have dissuaded some from seeking treatment.

Parity Laws Support Coverage

As an official disorder, binge-eating disorder should now be covered by the federal Mental Health Parity and Addiction Equality Act, which took effect in 2008.  The law requires that any group health plan covering 50 or more employees provide mental health benefits on par with those provided for medical care.

The law applies to all financial requirements, including deductibles, copayments, coinsurance and out-of-pocket expenses, and to all treatment limitations, including frequency of treatment, number of visits, days of coverage and other limits.

While insurers have generally been receptive to providing coverage for binge-eating disorder, they may now provide more comprehensive coverage.

 Coverage Sometimes Inadequate

That’s an important point, because coverage offered to date has often been inadequate.  In many cases, coverage for binge-eating disorder may not:

  • Include payment for advanced coverage, such as in-patient or residential care.
  • Allow coverage to continue long enough for the patient to recover fully.
  • Allow concurrent treatment for co-occurring disorders.  Most individuals with eating disorders have at least one additional disorder, such as depression.  The incidence of substance abuse is also higher among those with eating disorders than with the general population.  Chances of recovery improve greatly if co-occurring disorders are treated concurrently.

Of course, it’s too early to say how much of an impact inclusion of binge-eating disorder in DSM-5 will have on insurance coverage, but it can only help.

Dr. Stuart Koman

Stuart Koman, Ph.D. is President and CEO of Walden Behavioral Care and the nonprofit Walden Center for Education and Research, both in Waltham, Mass. He has 30 years of experience leading and developing behavioral healthcare companies.