The case hinged on application of California’s 1999 mental health parity law. A federal mental health parity law was passed in 2008. However, many insurance companies continue to deny coverage for residential treatment of eating disorders or other mental or emotional conditions, which can reach costs of more than $1,000 per day. Most professionals in the field feel there is “no question” that residential treatment can be a life-saving option for some patients who are battling eating disorders such as anorexia.
In the Monday (June 5) ruling, the court confirmed its original decision that the California Mental Health Parity Act requires health plans to provide coverage of “all medically necessary treatment” for “severe mental illnesses” under “the same financial terms as those applied to physical illnesses.” In the latest decision, the court held that health plans in California are obligated to pay for residential treatment for people with eating disorders even if the policy excludes residential treatment.
Commented Lynn Grefe, president and CEO of NEDA, “The Harlick ruling is a significant victory in the battle against eating disorders that we hope will have repercussions throughout the health insurance industries. Having a loved one struggling with an eating disorder is difficult enough without needing to go to war with your insurance company. Patients have been discriminated against by insurers through the years, so we hope this ruling will help turn the tide. Eating disorders can be deadly, but with appropriate treatment, recovery is possible. Insurance coverage for treatment is vital to that recovery.”
The California case revolved around Jeanene Harlick, an anorexia sufferer who received lifesaving treatment several years ago at a residential facility in St. Louis. Harlick had battled anorexia for more than 20 years. When her condition worsened in 2006 – despite intensive outpatient therapy – she checked into the Castlewood Treatment Center, where a feeding tube was required to sufficiently increase her caloric intake. Blue Shield of California refused to pay for Harlick’s nine-month stay, likening it to assisted living care, which her policy did not cover. Harlick filed a complaint in federal district court in 2008 – with her lawyers arguing that undergoing residential treatment for anorexia is more comparable to receiving care at a skilled nursing facility, something that was covered by her policy – but the court sided with Blue Shield. Harlick appealed the decision and was victorious.
Commented Lisa Kantor, of Los Angeles-based law firm Kantor & Kantor, who represented the plaintiff, “We appreciate that the court not only denied Blue Shield’s request for rehearing and rehearing en banc but also issued a new opinion with added clarity about the broad scope of California’s Mental Health Parity Act. The majority opinion takes a common sense approach in interpreting the act and accomplishes the legislative purpose of mandating full coverage for severe mental illnesses.”
An estimated 24 million Americans suffer from eating disorders. These disorders have the highest fatality rate of any psychiatric disorder.
The National Eating Disorders Association (NEDA), headquartered in New York City, is the leading U.S. non-profit organization supporting individuals and families affected by eating disorders. NEDA serves as a catalyst for prevention, cures and access to quality care. Each year, NEDA helps millions of people across the country find information and appropriate treatment resources through its toll-free, live helpline, its many outreach programs and website. NEDA advocates for advancements in the field and envisions a world without eating disorders. For more information, visit www.NationalEatingDisorders.org
For Treatment Referrals, Visit www.NationalEatingDisorders.org
Or Contact NEDA’s Live Helpline: 800-931-
Monday – Friday: 9 a.m. – 5 p.m. (EST)
Greenleaf & Associates — 323-660-5800
Vicki Greenleaf — email@example.com
Karen Brundage — firstname.lastname@example.org
Available for Interviews:
• Lynn Grefe, President and CEO of NEDA.
• Lisa Kantor, Kantor & Kantor, who legally represented Harlick
• Doctors, psychologists & other eating disorder treatment specialists throughout the country.
• Recovered eating disorder patients.
• NEDA ambassadors.