In August, the United States Court of Appeals for the Ninth Circuit ruled that, under California’s mental health parity law, insurers must pay for residential treatment for those with eating disorders and other mental health disorders. Many other states have enacted similar laws and, indeed, the federal government did in 2008. The ruling in California is one of the first by a high federal court and is being closely watched.
The defendant in the suit, Blue Shield of California, is calling for the case to be reheard, on the grounds that the decision means that insurers will have to pay for unlimited amounts of treatment, with a resulting rise in insurance costs. At least one advocate for those suffering from eating disorders says that she has seen an increase in insurance companies denying residential treatment.
Insurers Wary of Costs of Treatment
Residential treatment for eating disorders can cost more than $1,000 a day in some cases and insurers have tagged such treatments as lacking sufficient proof of success and of being more akin to education. Even some doctors note that few studies prove that residential care is effective in treating patients with anorexia nervosa and bulimia.
In New Jersey, Aetna, Horizon and AmeriHealth have agreed to end limits on the number of days of residential treatment they will cover for eating disorders, according to Bruce Nagel, a lawyer who sued the insurers under the state’s parity law.
The Parity Implementation Coalition, a group monitoring the federal parity law, has filed about 150 complaints about possible violations, according to Dr. Henry Harbin, a psychiatrist and adviser to the group. Some cases involve denial for residential treatment for substance abuse or mental illnesses by plans offered by companies like Wal-Mart and Coca-Cola Bottling.
Sam Menaged, founder and president of the Philadelphia-based Renfrew Center, one of the oldest and largest residential treatment centers for eating disorders, says that only 60 percent of insurers covered therapy for those with eating disorders, and that hundreds are turned away every year.
Many anorexics and bulimics contend that, whatever studies say or do not, residential treatment can be life-saving. Eating disorders affect an estimated 11 million American, mostly women, and have the highest fatality rate of any psychiatric disorders
Insurance, Autism and Behavior Therapy
The insurance companies’ resistance to covering residential treatment for eating disorders draws on similar arguments as have been used in arguing against covering behavioral treatment for autistic children. Such behavioral treatment for autism — often in the form of Applied Behavior Analysis or ABA — is also a widely practiced method for teaching autistic children in public and private schools. While in practice ABA involves a therapist or teacher repeatedly having a child perform certain tasks, behind what looks like educational drills is an understanding of the behavioral science of psychologist B.F. Skinner. On successful completion of a programs of tasks, a child receives “positive reinforcement” — sometimes food but also verbal praise, a toss in the air, playing with a favorite toy — with the idea that he or she is then more likely to do that task again.
Some programs for treating patients with eating disorders also use behavioral principles to teach an anorexic or bulimic how to eat again. A patient might have to eat a certain number of calories a day, in order to do such things as take a walk or not be placed on bedrest.
Treatment in a residential facility can be especially important for someone with eating disorders as it is round-the-clock. Also, simply being in a different environment (i.e., a treatment facility instead of one’s home or one’s parents home) can help. Someone with an eating disorder may not completely recover after such treatment, but can at least have absorbed some healthier eating practices that can help her or him get on with their lives and, gradually, overcome the disorder. As in the case of autistic children, the effects of behavioral therapy may not be seen quickly and may require extended years of therapy.
Obviously that’s not what insurance companies want to hear. The United States Court of Appeals should uphold its ruling about paying for residential treatment for eating disorders. The ruling not only makes a difference in the lives of many with eating disorders. Residential treatment for anorexics and bulimics can mean the difference between life and death.
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