Anorexia nervosa. Hospitalization on adolescent medicine units and third-party payments

To determine the appropriateness of hospitalization for patients with anorexia nervosa on an adolescent medicine unit, major and minor criteria justifying admission were developed. Hospitalization was considered necessary when one major and three minor, or six minor, criteria were met. A retrospective review of 20 patient records was conducted and all met the criteria. Eighteen patients were discharged with objective findings of improvement. Two were transferred to a psychiatric unit for prolonged care. A review of the financial records disclosed that four hospitalizations had been contested (partially or in total) by the patients' insurance company. Thus, in 20% of the records meeting the criteria for admission third parties refused to pay. Because insurance company denial may seriously undermine therapy and adversely influence outcome, it is proposed that a category of "Malnutrition Secondary to Anorexia Nervosa" be accepted as reimbursable under medical coverage for acute care treatment in qualified adolescent medicine units.