How to find a suitable treatment setting

Several considerations enter into finding a suitable treatment setting for a patient. Options need to be guided by the patient’s available insurance coverage, by whether a particular center or therapist accepts insurance, and by the patient’s ability to pay in the absence of insurance. Primary care physicians (family doctor, pediatrician, internal medicine doctor, gynecologist) can often play a valuable advisory role in referring patients for treatment because they may have experience with various centers or outpatient therapists.

Determining quality of care for bulimia

In January 2016, The Joint Commission, the oldest and most widely recognized healthcare accrediting body in the United States, issued specific accreditation criteria for eating disorders centers that became effective July 1, 2016. These criteria were developed over a 10-year period through a collaboration by key professional medical societies focused on eating disorders. This set of standards specifies requirements healthcare facilities must meet to receive accreditation for providing eating disorders care. Joint Commission accreditation is considered the gold standard in healthcare accreditation, and treatment centers undergo a rigorous review process before being designated a Joint Commission–accredited facility.

Another issue regarding quality of care is that much care is delivered on an outpatient basis. For individual psychotherapists or psychiatrists in private practice, no special credentialing or board certification exists for treatment of eating disorders, including bulimia nervosa. Efforts are ongoing to establish formal programs for focused training in eating disorders at a few academic institutions. However, any mental healthcare professional can offer to treat an eating disorder regardless of experience or training specific to eating disorders. Therefore, it is important to ask prospective therapists being considered to treat bulimia nervosa about their knowledge and experience treating eating disorders. Some important questions to ask a therapist are provided here in the checklist, Questions to Ask an Outpatient Therapist.

Factors affecting access to care

For insured patients, the choice of treatment center is often dictated by the beneficiary’s health insurance plan. Health insurers should provide a list of in-network (covered) treatment centers. If the treatment center is outside the health insurer’s system (out-of-network), the insurer might pay a percentage of the treatment costs, leaving the patient responsible for the remainder. It is best to negotiate this percentage with the insurer before starting treatment. A few treatment centers offer financial assistance, but most do not. However, inquiring about treatment scholarships, as they are termed, may be worth investigating if the patient does not have financial resources or insurance.

Costs aside, other factors can be important to the patient in selecting a treatment center:

    • The treatment center’s philosophy (or religious affiliation, if any),
    • Multidisciplinary approach to care
    • Distance from home, staff/patient ratio
    • Professional qualifications and experience of staff in treating bulimia nervosa
    • Adjunct therapies offered

Adjunct therapies offered in addition to psychiatric counseling and pharmacotherapy may include therapy with horses, meditation, massage, dance, or art therapy. These therapies may be appealing, but they also may not be covered by insurance. Therefore, it’s important to find out what is covered and what the patient might be billed for if using these adjunct treatments. Important questions to ask treatment centers are provided in the checklist, Questions to Ask When Seeking a Treatment Center.

Another important consideration is the type of care team a facility typically uses. Below is a list of the types of professionals who are generally recommended to be part of the care team to ensure well-rounded care. Once a treatment facility decision has been made, there is another checklist of questions, Questions to Ask the Care Team, you may want to ask the care team.

Lastly, patients or family (parents) may want to ask the treatment facility and care team some questions separately. See Questions Patients May Want to Ask Treatment Providers Privately and Questions Family/Partners/Friends May Want to Ask Treatment Providers Privately. Depending on the patient’s age, you may need written permission to speak about the patient with a treatment facility or member of the care team. Please see Confidentiality Issues.


Professionals in a multidisciplinary care team for bulimia nervosa

    • Primary care physician (family doctor, internal medicine doctor, pediatrician, gynecologist)
    • Psychiatrist
    • Nutritionist
    • Clinical psychologist
    • Psychopharmacologist (psychiatrist, clinical psychologist, pharmacologist with special knowledge about medications used for mental disorders)
    • Social worker
    • Claims advocate for reimbursement
    • Other professionals who administer supplemental services such as massage, yoga, exercise programs, art therapy, movement therapy