Eating Disorder Treatment and Insurance Issues
HARLICK v. BLUE SHIELD OF CALIFORNIA
NOTICE: ON AUGUST 26, 2011, THANKS TO THE EXCELLENT EFFORTS OF ATTORNEYS LISA KANTOR AND ELIZABETH GREEN OF Kantor & Kantor, LLP, THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT RULED IN FAVOR OF JEANENE HARLICK AND HELD THAT CALIFORNIA'S MENTAL HEALTH PARITY ACT REQUIRED BLUE SHIELD TO PAY FOR HER CARE AT A RESIDENTIAL TREATMENT FACILITY. READ THE COURT'S DECISION BY CLICKING ABOVE.
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. Kantor & Kantor, LLP has developed a specialized legal practice representing clients whose claims for treatment of eating disorders, and dual diagnosis (substance abuse and other co-morbid conditions) have been unfairly denied by their health insurers or benefit plan. Kantor & Kantor, LLP's aggressive approach to litigation and legislation has brought justice for clients who have found themselves fighting for their insurance benefits when benefits were wrongfully denied.
Kantor & Kantor, LLP (K&K) 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 many clients, residential treatment is the most appropriate and effective level of care for treatment of their eating disorder and related conditions.
The American Psychiatric Association's Practice Guidelines include residential treatment as an essential step in the spectrum of treatment for eating disorders, falling between inpatient hospital care and outpatient care. Professionals involved in the treatment of eating disorder have produced concrete evidence that residential care treatment is optimal to prevent relapses and promote healing because it addresses both medical and psychological issues. Some insurers ignore this accepted standard of care, however, providing coverage only for hospitalization or outpatient care.
In order to obtain residential care, policyholders frequently must sue their health plan or insurer to pay for treatment. That's where we come in. We are one of only a few legal practices in the United States that will represent eating disorder patients denied health benefits for residential treatment.
We represent clients in litigation and are available to advise clients during the administrative appeals process. We also appeal cases to the Ninth Circuit Court of Appeals if necessary.
In addition, we fight for our clients in the legislative arena, appearing at administrative hearings before state insurance boards to inform lawmakers of standard of care issues surrounding eating disorders when crafting laws that govern insurance benefits.
Our advocacy in the area of eating disorders has changed California law regarding the way insurers pay benefits for eating disorder care. Below are a few examples:
- K&K challenged a lower court decision regarding a health plan's refusal to comply with the state's mental health parity law in refusing residential treatment to a policyholder with anorexia. [link to Harlick materials]
- K&K successfully petitioned the California Department of Managed Health Care on behalf of a client with anorexia being discharged from a residential care facility because her insurer refused to pay for treatment. [link to Shepard materials]
- K&K recovered benefits for a client suffering from bulimia when her medical plan declined to refer her to an out-of-plan treatment facility and refused to pay for the cost of treatment. The California Court of Appeal ruled that the decision to place our client in residential treatment, rather than follow the health insurers flawed treatment decisions, may have saved our client's life. [link to Jacob materials]
K&K prevailed at trial and on appeal when the 9 th U.S. Circuit Court of Appeal determined our client was entitled to long-term disability benefits after her employer changed its policy definition to exclude her eating disorder. The court ruled that the plan in effect at the time of disability was the plan that governed the disposition of benefits.
[link to Shane materials]
- K&K received the first published appellate decision in California for an eating disorder case where our client was denied benefits for in-patient treatment of bulimia. The Court of Appeal interpreted California's mental health parity law to include beneficiaries from California policies who did not live in California and sought medical care outside of California.
Recently, Kantor & Kantor, LLP Partner, Lisa Kantor, spoke in Washington D.C. at a Congressional Briefing on the subject of Eating Disorders, and in favor of the FREED Act which seeks to draw attention to, and direct resources toward Eating Disorders and their treatment. You can read Ms. Kantor's speech by clicking this link: FREED ACT Speech