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Eating Disorder Claims

Eating Disorder Treatment and Insurance Issues in California

Kantor & Kantor, LLP Understands Your Difficult Situation

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.

HARLICK v. BLUE SHIELD OF CALIFORNIA NOTICE - On August 26, 2011, thanks to the excellent efforts of attorneys Lisa Kantor & 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 the link above.

Residential Treatment

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.
  • 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.
  • 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.

We can help! Contact us today to get started.

Hear From People We've Helped

5 / 5 stars
First of all, I want to express my extreme gratitude for probably saving my daughter's life. By staying in treatment, the improvement is remarkable. She had been in eating disorder facilities many times, and treatment had been interrupted repeatedly by Anthem Blue Cross's denying benefits. Many of the health professionals were telling me that maybe my daughter was a hopeless case. You both gave me hope. She is still struggling with some residual issues around eating, but the change in her attitude, her ability to assess her own recovery, and her wish to live instead of to die, is evident in her life. Now she is back in school, after years of having her education disrupted by the eating disorder. She goes places with friends, and even goes out to restaurants for fun! This year marked the first holiday season for many years, when she had not been in a treatment facility. Other people gave up and you didn't. I can't thank you enough. You took the action that was necessary to keep my daughter in treatment long enough for it to work.

What Sets Us Apart?

  • Free Case Consultations Provided
  • 160+ Years' Collective Experience
  • Thousands Of Cases Successfully Handled
  • You Don't Pay Us Unless We Recover Your Claim
  • Selected For Inclusion In The List Of Super Lawyers®

Client Testimonials

  • You've helped to remove a great burden from our lives. It's nice to know there are decent people still in the world.

    “Thank you for your kind efforts. You've helped to remove a great burden from our lives. It's nice to know there are decent people still in the world.”

    B.

  • The arguments you made on our behalf at the mediation resulted in a more positive outcome for our case than we could have otherwise expected.

    “We appreciate that you found merit in our case, and that you were both willing and able to be present at the mediation. We believe that the arguments you made in our favor to the mediator were able to influence the outcome towards resolution that we could feel satisfied with. In the end, we believe that your counsel, your support, and the arguments you made on our behalf at the mediation resulted in a more positive outcome for our case than we could have otherwise expected. Throughout you were always professional, but direct and clearly firm on our position. We thank you for your efforts to resolve our dispute to our satisfaction, and wish you continued success.”

    Mara T.

  • I won the appeal.

    “Hi Glenn- This is a very belated thank you for your generous assistance and advice last summer, when I was appealing UBH's decision for my son. I won the appeal, at least for care at the partial hospitalization level (they wouldn't budge on residential, but the facility was accepting the partial care reimbursement for residential treatment). But the appeal was a great moral victory, and I think it's a great thing to have in the record, just in case he needs to go for treatment again. Thanks again for your generous help, I was very grateful for it. Wishing you a most happy Thanksgiving.”

    Terry S.

  • Thank you a zillion times for your patience and time and absolutely helpful information.

    “Thank you a zillion times for your patience and time and absolutely helpful information. You've helped me understand my position with my disability insurance and payments so much better. There is some real comfort in feeling anchored in knowledge…of what is and what might be in the future. Thanks to you!”

    B.

  • There are no words that can express the feelings of gratitude and relief I have that you helped us.

    “I wanted to thank you again for all of your help. My daughter would not be in treatment without your help. I can never thank you enough, there are no words that can express the feelings of gratitude and relief I have that you helped us, and I believe saved my little girl. Taking her back to Timberline Knolls was very difficult in many ways, I wish UBH could know the damage they have done to her by having her go in and out like this. When she went into Timberline Knolls the first time she was not happy to go exactly, no one wants to go into treatment, but she was open to going in and ready, for the first time, to really look at her issues and work hard to get better. When she had to leave Timberline she expressed that she wished she could have stayed because she felt like she was finally at a place where she was getting better and, though it was hard, she was really opening up and dealing with her issues for the first time, something she has had a hard time doing. I just wanted you to know that she was going down to a really bad place and without you I don't know what would have happened except that she would not be at Timberline Knolls right now getting better and I thought you should know this. With unending gratitude.”

    R.