Eating Disorder Legal News & Updates

California Eating Disorder Articles & Information

Eating Disorder Cases Represented by Kantor & Kantor

Shepard v. United HealthCare

DMHC Orders United Healthcare to Pay Benefits to Anorexia Patient

Kimberly Shepard, a young wife and mother, was in danger of losing her life from the debilitating effects of Anorexia Nervosa because her health insurer United HealthCare Insurance Company declined her claim for benefits to pay for residential treatment. Kantor & Kantor, LLP appealed to the California Department of Managed Health Care requesting that the DMHC immediately submit Shepard's case to an independent doctor for an examination and review after the U.S. District Court for the Eastern District of California denied Shepard's temporary restraining order to enjoin United HealthCare from continuing to withhold benefits.

Shepard sought treatment at Monte Nido residential treatment center in Calabasas, California, a preferred provider under Shepard's health policy. Although Shepard's condition more than met the policy's conditions for residential treatment, United HealthCare denied her claim. As a result, Shepard exhausted her family's financial resources to pay for treatment.

Within a month, the DMCH ruled that inpatient services at a residential treatment facility were medically necessary and ordered United Healthcare to resume payment for such care.

Thompkins v. BC Life and Health

Kantor & Kantor, LLP won the first published district court decision in California in an eating disorder case in which a client was denied benefits for in-patient treatment of bulimia. Thompkins v. BC Life and Health Ins. Co., 414 F.Supp2d 953 (C.D.Cal. 2006).

Amy Thompkins suffered from bulimia and required inpatient treatment at a residential care facility. After first agreeing to pay for such treatment, BC denied benefits after less that four months, saying Amy no longer required inpatient treatment despite assessments from her therapists that proved otherwise.

The District Court interpreted California's mental health parity law AB88, which requires health insurance policies to cover treatment for mental illness (including eating disorders) on the same terms and conditions applied to other medical conditions, to include beneficiaries who did not live or seek medical care in California but whose policies are issued in California. The court ruled Amy was entitled to continued benefits under her medical plan.

Harlick v. Blue Shield

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.

 

 

 

News & Updates

Kantor & Kantor, LLP is challenging denial of benefits on behalf of Jeanene Harlick in an appeal to the 9 th U.S. Circuit Court of Appeals, which reviews cases that fall under the federal Employee Retirement Income Security Act, the law that governs employer-provided health plans.

Jeanene has suffered from anorexia for more than 20 years. Her physicians, backed by extensive research and professional recommendations, facilitated her admittance into residential treatment as perhaps the only option that could successfully treat her illness. After initially agreeing to coverage, Jeanene's health insurer Blue Shield of California refused to pay for the treatment because, they insisted, residential care is not covered in her policy. Whether or not this assertion is accurate is unclear because the policy is written is such a way that leaves the question of residential care coverage open. Indeed, Blue Shield changed its mind several times about what was or was not covered, and provided alternate and competing reasons for denial. And despite Jeanene's requests, Blue Shield never explained why the California Mental Health Parity Act did not require payment of her claim.

We have petitioned the 9 th Circuit to review and overturn the lower court's decision that Blue Shield did not abuse its discretion when it denied Jeanene's benefits. We assert that Blue Shield's statement that residential care is not covered, is a violation of California's Mental Health Parity Act.

We hope to see health plans apply California's Mental Health Parity Act and provide benefits to individuals seeking residential treatment for eating disorders. It would reinforce state law that mandates mental illnesses be treated under the same terms and conditions as other medical conditions. And it could enable thousands of people suffering from eating disorders to finally receive the comprehensive, often life-saving treatment to conquer their disease.

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