The tide is turning on coverage for nutritional counseling for eating disorder patients. Many eating disorder patients are wrongfully denied coverage for nutritional counseling despite evidence that such treatment is an effective component for the treatment of eating disorders.
On August 22, 2016, New York Attorney General Eric T. Schneiderman announced a settlement with HealthNow, New York, Inc., after an investigation uncovered the wrongful denial of thousands of claims for outpatient psychotherapy and more than one hundred claims for nutritional counseling for eating disorders. The wrongful denials totaled more than $1.6 million in patient claims according to a press release on the Attorney General's website. http://www.ag.ny.gov/press-release/ag-schneiderman-announces-settlement-healthnow-new-york-over-wrongful-denial-16
Attorney General Schneiderman stated that "Insurers have a legal obligation to provide the same level of care to patients being treated for behavioral health conditions as they do for patients with other ailments." According to the press release, HealthNow denied approximately 125 sessions of nutritional counseling to members with eating disorders claiming that the service was not a covered benefit. As a result, members were charged a total of approximately $14,000 for these medically necessary treatments according to the press release. HealthNow did provide coverage for nutritional counseling visits for medical conditions such as diabetes. Pursuant to the settlement, "HealthNow will also cover nutritional counseling for eating disorders, including anorexia nervosa and bulimia nervosa."
We anticipate this will result in other states requiring their insurers to provide fair coverage for patients with eating disorders at the same level of care for patients with physical conditions.