Eating Disorder Patients Fight Twice the Battle: Their Illness & Their Insurance Carrier

Posted By Kantorlaw || 17-Feb-2012

The Battle

A national struggle persists, and threatens the lives of roughly 11 million Americans. Eating disorders, the deadliest of all mental health illnesses, torment millions of people, and only one in ten get the treatment essential for recovery (Making Peace with Women's Bodies).

The Emily Program (one of the largest eating disorder treatment facilities in the country) estimates that about 10-15 percent of clients are denied full coverage from their insurance companies.

Kathleen MacDonald, of the F.R.E.E.D. Foundation, reported on a recent informal survey: of 100 patients with insurance, less than half had coverage for eating disorder treatment. Of the half who did, the coverage was limited.

People are tragically being discharged because their insurance company says they're done, rather than their doctors or treatment team saying they're ready. An unfortunate piece of the battle is that many of these people, who are denied coverage by their insurance companies, are in a fragile place and aren't able to fight back. Thus, they simply stop seeking treatment, or pay for it themselves and don't seek reimbursement.

There has however, been a trend of more lawsuits, and eating disorder advocates are demanding that patients get the treatment that they are entitled to. In 2008, the Mental Health Parity Act stated that mental and behavioral disorders must be covered in the same way as physical ailments. This was tremendous progress; nonetheless, insurance companies still find ways to deny coverage through loose interpretation of the law.

In August of 2011, attorney Lisa Kantor won the landmark case (Harlick v. Blue Shield) in California, which determined that state insurance companies must pay for residential treatment for eating disorders and other serious mental illnesses. This ruling has impacted other cases, including Burton v. Blue Shield, and eating disorder advocates are anticipating that other states will follow suit.

A Closer Look

Katie Bird has been battling an eating disorder since the age of 13. Like many others in treatment, Bird spent her days in outpatient programs, fearful of when her insurance company would pull the plug and treatment would cease. It's extremely difficult to concentrate on the demands of recovery, when you could be asked to leave at any moment.

"It was frustrating and shocking and scary and sad to see the revolving door that treatment is," Bird said. "People would be approved [by insurance companies] for three days, and then the insurance would reevaluate. That was the case all the time. You'd get an hour's notice and you'd have to leave. It was really disruptive to everyone's treatment, because you all kind of form a treatment family, and if one is leaving, it makes it hard because you don't know how deep you can go before you're going to get kicked out."

Ultimately, what they decided to do with Bird was check her into the Anna Westin House (a residential house that is party of the Emily Program) even though they knew UBH would deny her claim. Afterward, they would sue to recover benefits. Residential treatment was essential to Bird's recovery, consequently her family and treatment team were left to think outside of the box. Bird is currently in full recovery.

The Impact

Today is a very important day. The Anna Westin House, the facility where Katie Bird was treated, was named after Anna Westin, who died 12 years ago today. Anna suffered from Anorexia and passed away at the young age of 21. Anna Westin's insurnace company would not cover treatment properly for her eating disorder. Her mother, Kitty Westin, believes that Anna would still be alive today if she would have had access to a residential program.

Anna and Kitty are in our hearts today.

To read more about Katie Bird and insurance issues with eating disorder coverage, read this article http://www.minnpost.com/health/2012/02/eating-disorder-patients-fight-double-battle-their-disorder-and-insurance-firms.

We Can Help

Dealing with, and seeking treatment for eating disorders can be emotionally and financially devastating. When your health insurance company gives you a hard time, or when it denies payment for benefits, matters only go from bad to worse. We can help.

Lisa Kantor represents an increasing number of young women and men suffering from life-threatening eating disorders and dual diagnosis conditions, whose health plans refuse to pay for required treatment on the grounds that such life-saving treatment is "not medically necessary," only necessary at a lower level of care, or is limited by plan terms.

For more information on eating disorders legal assistance, call Kantor & Kantor, LLP at (888) 569-6013or click here:

http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx

http://www.facebook.com/pages/Eating-Disorder-Legal-Assistance/163785873661013

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