Eating Disorders Health Insurance
Anorexia and Bulimia Treatment Coverage
When Jeanene Harlick suffered a relapse in her 20-year battle with anorexia in 2006, her doctor advised her that only a residential treatment facility could provide the level of care that she needed. Dangerously underweight, the California woman checked into Castlewood Treatment Center in St. Louis, where she was given nutrition via a feeding tube and stayed for more than 9 months before being discharged.
When Harlick’s insurance company repeatedly refused to pay for her stay at Castlewood, stating that her policy did not cover residential treatment, she sued for reimbursement of her claim. In August, a federal court ruled that Blue Shield of California must compensate Harlick for the costs of her treatment.
The decision in Harlick v. Blue Shield of California has given new hope to many people suffering from severe eating disorders, and could mark a turning point in the application and enforcement of parity laws intended to force insurers to put coverage of mental health treatment on the same footing as coverage of treatment for physical illnesses and injuries.
According to Dr. Gregory Jantz, an eating disorders specialist in Edmonds, WA, it’s about time that the U.S. health care system recognized the special role that residential facilities can play in the treatment of severe cases of anorexia and bulimia. Jantz founded and operates The Center for Counseling and Health Resources, a residential treatment center based in Edmonds, WA. Dr. Jantz is also author of Hope, Help and Healing for Eating Disorders and many other books on mental and emotional well-being.
"Because eating is an activity that takes place throughout the day, it's difficult for care providers to know whether a person with an eating disorder is really consuming the number of calories that we've recommended for her," said Dr. Jantz. "Only round-the-clock residential care allows monitoring of someone's food intake."
In cases of bulimia, which involves binge eating followed by purging through vomiting and laxative use, it can be difficult outside of a residential care setting for a care provider to know whether someone is actually retaining the food they’ve eaten.
Eating disorders disproportionately affect girls and women, who account for 90 percent of cases, and they can be deadly. Anorexia has the highest death rate of any psychological disorder, meaning that proper intervention, especially in severe cases, can make the difference between life and death.
“Even intensive outpatient programs for eating disorders don’t allow the opportunities for observation and intervention that a residential setting affords to therapists, nutritionists and nurses,” said Dr. Jantz. In Harlick’s case, her regular doctors recommended that she seek residential care because her condition was worsening despite her participation in intensive outpatient treatment.
The U.S. Court of Appeals for the Ninth Circuit ultimately ruled that California’s mental health parity law required that Harlick’s insurer cover her residential treatment for her anorexia because, given her condition in 2006, it was “medically necessary.” The court said that a policy that covers all medically necessary treatments for physical conditions should also do the same for mental disorders, even if there is no clear analogue on the physical side for the kind of residential treatment that Harlick received for her anorexia.
The state of California enacted its mental health parity law in 1999, and a federal mental health parity law was passed in 2008. Some insurers around the country are clarifying their policies in an attempt to exclude residential treatment for mental health issues, and the Harlick ruling is expected to continue to have repercussions throughout the health care and health insurance industries. Blue Shield of California has already filed for a rehearing of the case.
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