Insurer Settles Class Action Seeking Medical Coverage for Eating Disorders
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For the second time in the last six months, a healthcare insurance company has settled a class action seeking to establish that treatments for eating disorders such as bulimia or anexoria should be covered like other biologically based psychological disorders like schizophrenia. This time, Horizon Blue Cross Blue Shield of New Jersey agreed to pay $3.6 million to settle the case and, according to the New Jersey Law Journal, further agreed to have all disputes regarding coverage for treatment of eating disorders resolved in binding arbitration by an eating disorder specialist. The settlement still needs the approval of the Federal Judge presiding over the case.
The impact of this decision for those with eating disorders is dramatic. The treatment for these disorders often requires intensive psychological and nutritional interventions on an inpatient basis, with an extensive post-treatment follow-up. Many insurance carriers have limited the number of visits or raise immediate questions regarding the extent of coverage available for these disorders. This itself inhibits those suffering with the disorders from seeking the expensive therapy.
By placing eating disorders on a parity with other biologically based mental illnesses, coverage would be recognized in the vast majority of eating disorder cases. In the first case of this kind, where a similar settlement was reached six months ago, Aetna pledged to re-educate its claims staff regarding the nature of eating disorders and accept coverage when appropriate. In the current Horizon settlement, no similar pledge was made. All that has changed is that Horizon Blue Shield has agreed to revamp its dispute resolution procedure when such a coverage issue arises. Only time will tell if this is an adequate protection for those suffering the disorders.
To this author, the placement of eating disorders on a parity with other mental based or emotional based disorders recognized for coverage is a "no-brainer." The majority of those suffering from eating disorders are young and otherwise healthy. The long-term health implications of untreated eating disorders, however, are serious if not grave. Why not nip it in the bud now and avoid the high costs of long-term or critical care that will arise when the disorder tips into irreversible digestive, kidney and autoimmune system diseases.