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Residential care 'medically necessary' for eating disorders?

December 7, 2011
by News release
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Edmonds, Wash. — In the wake of a federal court ruling this summer that a California woman's insurance company should pay for residential treatment that she received for anorexia nervosa, psychologist Dr. Gregory Jantz echoed the court's opinion that residential care can be medically necessary to treat severe eating disorders.

Dr. Jantz, a nationally renowned specialist in eating disorders such as anorexia and bulimia, said that round-the-clock care can be required for such disorders because treating them effectively involves constantly monitoring patients' food intake and retention.

"Even intensive outpatient programs for eating disorders don't allow the opportunities for observation and intervention that a residential setting affords to therapists, nutritionists and nurses," said Dr. Jantz, who founded and operates The Center for Counseling and Health Resources, a residential treatment center based in Edmonds, Wash. Dr. Jantz is also the author of many books, including the best-selling Hope, Help and Healing for Eating Disorders, and operates the eating disorders website Caring Online.

According to Jantz, the California case revolved around Jeanene Harlick, an anorexia sufferer who received lifesaving treatment several years ago at a residential facility in St. Louis. Harlick had battled anorexia for more than 20 years, and when her condition worsened in 2006 despite intensive outpatient therapy, she checked into the Castlewood Treatment Center. Staff at Castlewood had to use a feeding tube to sufficiently increase Harlick's caloric intake.

Jantz said that Harlick's insurance company, Blue Shield of California, refused to pay for her nine-month stay at Castlewood, likening it to assisted living care, which her policy did not cover. Harlick's lawyers argued that undergoing residential treatment for anorexia is more comparable to receiving care at a skilled nursing facility, something that was covered by her policy.

The case hinged on application of California's 1999 mental health parity law. Parity laws were passed by some states to require insurers to cover treatment of mental illnesses to the same extent that they cover medical care or surgical procedures for physical ailments and injuries. A federal mental health parity law was passed in 2008, and the Harlick ruling is expected to have repercussions throughout the health care and health insurance industries.

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