Attorney Lisa Kantor presents her seminar topic “How to Document Evidence-Based Treatment to Maximize Benefits,” to the International Association of Eating Disorder Professionals (IAEDP) Friday, March 4, 2011, from 2:00 p.m. to 3:30 p.m., at the group’s annual conference in Phoenix, AZ. Ms. Kantor’s session will review the criteria from insurance companies for treatment of eating disorders and explain how evidence-based treatment records can be documented so as to comply with insurance company guidelines for reimbursement as much as possible.
“When seeking insurance benefits for eating disorder treatment, a provider’s records will be the foundation for establishing medically necessity for admission and continued treatment,” explains Ms. Kantor, a partner in the Los Angeles area law firm Kantor & Kantor, LLP. “Evidence-based treatment records must show plans of care, symptoms, and objective evidence that satisfy an insurance company’s criteria for admission and continued care.”
The primary reasons insurers deny treatment is “lack of medical necessity.” Insurance companies determine medical necessity by applying their criteria to the request for benefits. While criteria such as symptoms, plans of care and facility qualifications vary among the different health insurers, successful claims decisions almost always require thorough documentation from every member of the treatment team. Ms. Kantor’s presentation will instruct conference attendees how to create a document file that should meet insurer demands as well as create a record for appeal and litigation.
Ms. Kantor is among only a few lawyers in the country advocating for insurer reimbursement for clients with eating disorders. She has a number of significant wins, including eating disorder cases that have changed the law in California and the 9th Circuit. She is currently working with eating disorder professionals and facilities to determine what actions will change the insurance industry’s perception about care for eating disorders and what regulatory, legislative and class action litigation measures are necessary. Ms. Kantor has been a featured speaking for the Los Angeles, Orange County and San Diego chapters of the IAEDP.
For more information about obtaining insurance benefits for eating disorder treatment, log on to www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx or call (800) 446-7529.