The journey towards recovery can take many forms, but every person has to follow their own path towards health and make choices along the way. Some of these choices may come in the form of different treatment centers or levels of care to address the difficulties someone is having at that stage of their recovery. Every person’s process is different.

Eating disorders are very complex illnesses that require specialists to treat not only the emotional and behavioral facets of an illness, but the medical one as well. For these reasons, the American Psychological Association (APA) established guidelines for appropriate levels of care with eating disorders.

Chrysalis Center is an outpatient program and will soon be adding intensive outpatient (IOP) services. The other levels include partial hospital (PHP), residential, and inpatient levels; these last two are sometimes combined into an “IP-Res” format. To see the full APA criteria for eating disorders, click here. There are some other resources for eating disorder treatment in North Carolina, including Veritas Collaborative, Carolina House, and UNC’s Center for Eating Disorders.  Other treatment centers around the country specialize in eating disorders as well, and sometimes these other programs are a better fit for clients in terms of their individual needs and experiences.  Though not for eating disorders, there are several other levels of care in the Wilmington area for adolescents and adults in general psychiatry.

Usually, these difficult conversations start when we as clinicians recommend a higher level of care for someone who we do not think is appropriate for outpatient or IOP treatment. To be appropriate for outpatient or IOP, a person must be:

  • Medically and psychologically stable to the point that they are not a danger to themselves or others
  • Motivated to recover
  • Cooperative
  • Self-sufficient
  • Able to control their thoughts and behaviors using appropriate social support


When someone needs a higher level of care, they are usually:

  • Medically compromised (by weight, bloodwork, EKG, etc.)
  • Unable to manage their behavior
  • Un- or under-motivated
  • Not functioning in their lives in some significant way (work, family, relationships, etc.)
  • Unable to manage a co-morbid condition (psychological or medical) because of their eating disorder

Levels of care indicate how much structure, support, and observation a client requires at that stage in their recovery.

When someone needs a higher level of care, it can be a very difficult discussion between provider and client. Sometimes, we all know it is coming and have been trying to avoid it but it just is not working. Other times, clients may take a sudden turn. This could be for many reasons, but the important thing is that clients get the help that they need to recover from their eating disorder and co-occurring disorders. Our goal is always to help our clients and keep them focused on living healthy and productive lives, and we try to balance all their individual needs while keeping the goal of a full recovery foremost in our minds.

It is important to use the right tool to complete a task, and sometimes that tool needs to be a higher level of care in order for someone to truly recover. Often, IP-Res levels of care can get clients back on track faster than outpatient could and sometimes that is necessary for someone’s well being or even survival. PHP and IOP levels can provide support to keep someone out of the hospital or they can provide support as a step-down program. The transition between inpatient and home can be very stressful and there are a lot of facets to consider including social, family, academic, or work stressors. All of these are affected by or contribute to eating disorder behavior. A person cannot live in a vacuum so all of these need to be managed before someone goes back to their regularly scheduled lives.

By adding IOP services, Chrysalis hopes to provide a bridge for clients on their journey in recovery. It is an important stage or facet in that process. If you need us, we will be honored to work with you on that journey.


Kendra is a Senior Staff Therapist and soon to be Clinical Director of Chrysalis’s new Intensive Outpatient (IOP) program with 13 years of experience working with eating disorders in various settings, including inpatient, PHP, IOP, and outpatient treatment facilities.


It’s easy to shy away from learning about health insurance – it’s overwhelming just to get past all the acronyms that flood your mailbox when your new insurance cards arrive. Between ACA, EAPs, EOBs and HSAs, sometimes it’s easier to throw our hands up in the air and avoid determining how to best use health insurance. Instead, take a few minutes to look for key terms in your benefits booklet, talk with your HR representative, or the representative who sold you the policy.

In order to determine your cost for health care services, here are some questions you’ll want to ask your potential healthcare provider:

  • What type of service am I receiving?
  • Where will I receive this service?
  • Who is performing that service?
  • Does my insurance company consider the provider IN or OUT of network?

These are questions that any provider’s office will be able to answer, so ask them! Then you will be able to find out from your health insurance company what you’ll need to pay to receive specific services. You can call the number on the back of your health insurance card, go to the website for members, or look in the benefits booklet you received when your policy began.

Your insurance company will be able to provide you with your individual benefit for different types of services. Unless your insurance company covers certain services at 100%, you will be expected to pay a co-payment, co-insurance or the full amount for a service which will go toward your deductible. So what’s the difference between all these things? Let’s define these terms.

  • Co-payment: A fixed amount required by a health insurer to be paid by the insured for each visit or drug prescription.
  • Deductible: A specified amount of money that the insured must pay before an insurance company will pay a claim.
  • Coinsurance: A specified percentage of the total cost of the medical expenses after a deductible has been reached.

It’s important to understand that these rates are determined by your insurance carrier, not your health care provider. Healthcare providers can determine the amount they will bill your insurance company or any non-billable fees they may require from you, but your insurance company determines the amount you are required to pay as long as you see an IN-network provider.

The Chrysalis Center offers mental health counseling and nutrition counseling in an office setting with licensed therapists and registered dietitians. Mental Health counseling and Nutrition Counseling are separate benefits.  Our administrative staff will help you determine the cost you are responsible for when it comes to either service. We are in network with Blue Cross/Blue Shield, United Healthcare, Aetna, Medcost, Tricare and Medicare.

If you are considering mental health or nutrition services, take the time to find out how you can use your health insurance to pay a portion or even cover it in full. You may just find out that you have excellent benefits for these services!

About the author

Alexis is the Practice Manager at Chrysalis Center and performs multiple functions to support the business. Among those are supervising the administrative staff, acting as the Intake Coordinator, Human Resources and Marketing. Alexis was born and raised in Wilmington, graduating from NC State University in 2003. While not leading the team at Chrysalis Center, she enjoys spending time with her husband, Wes and her two boys: Mason (5) and Banks (2)

Alexis Hunter Practice Manager


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