Eating Disorders: Why Insurance Should Pay For Treatment

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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Photo by tobias fotografiert


Anne G.
Anne G5 years ago

Health Insurance companies have nothing to do with health in that if you are sick they want to help you get healthy, they just want to make money. The quick fix for anything, it's just sick. Of course people with eating disorders need to be in a controlled environment, how stupid can these companies be?

Sami R.
Samantha Read6 years ago

Insurance companies... what the hell is wrong with you? Why would you single out eating disorders when it can be put in the same basket as things that are obviously seen as 'worse' such as cancer? the bottom line is they are no different! and just as destructive to the family and the individual! would you rather not pay and let them continue to go through this pain without having residential care, which is aparently 'not proven to work'? Im sure the insurance companies would feel alot different if it were someone in THEIR family who was suffering.

Ashleigh C.
Ashleigh C6 years ago

insurance companies and the lawyers that assist them make me more than angry.

Dave C.
David C6 years ago

just one more reason for a single payor health care companies want to make money first and not necessarily help their clients get better........horrible disease and residential treatment is a great treatment option...should be fully supported....

Claire M.
Claire M6 years ago

Its actually amazing how many health threatening issues insurance companies do not want to cover because they might have some cosmetic benefit. Its like there is a taboo on it or something.

Julie Jane
Julie J6 years ago

My sister has suffered for several years with an ED. She has been lucky enough to be allowed to participate in day release programs (in the UK), but not a residential program. At the moment, she is 'bad' but not 'bad enough' to warrant financial support for a residential program. So I can empathise here. Suffers of EDs need as much help as they can get - as alone they will just continue to suffer.

Marie W.
Marie W6 years ago

Insurance just wants to collect $$$ not spend them.

sandra m.
Past Member 6 years ago

ANYTHING that has to do with one's physical and/or mental health should be covered by health insurance!!......

Marilyn L.
Marilyn L6 years ago

"Help those already suffering. And prevent it from happening to others"
I agree Bianca so we must:
1. have national health insurance
2. We must regulate the foods on the market much better so they are healthier and safer.
3. We must go back to smaller healthier local farms
4. We must insist that physicians, hospitals, clinics, all care givers start practicing and provide preventative medicine.
5. We must insist that the medical community research its way out of the practice of medicine by prescription drugs.
I think this is all possible, it is up to the people to demand and accept nothing less than a healthier society.

Gina P.
Regina P6 years ago

Eating disorders are a mental health diagnosis - insurance treats depression, bipolar disorder, schizophrenia - why single out eating disorders. After dealing with one in the family, I am just thankful we didn't need inpatient, but handled it outpatient and she is well now. But I know one of her friends who died of it and what a loss to her family. This is just insurance companies being cheap. I will accept it the day they stop making their big profits.