Pekin, Ill. — Through the efforts of Los Angeles attorneys Lisa Kantor and Elizabeth Green of Kantor & Kantor, LLP, the 9th U.S. Circuit Court of Appeals has ordered Blue Shield of California to pay for a policyholder's anorexia treatment, alerting insurers to treat mental illness "under the same financial terms as those applied to physical illnesses."
The federal appeals court, in Harlick v. Blue Shield of California, (No. 10-15595, Aug. 26, 2011), ruled that although the Blue Shield health insurance policy for plaintiff Jeanene Harlick did not require coverage of her treatment at a residential facility, the plaintiff's treatment for anorexia was medically necessary, and the California Mental Health Parity Act required Blue Shield to pay for treatment.
Jeanene Harlick struggled with anorexia for more than 20 years, and she often required emergency room assistance with the insertion of a feeding tube. After a recommendation from her doctor – when her body weight fell below 65 percent of the ideal -- Harlick entered the Castlewood Treatment Center in St. Louis in April 2006 for 10 months, which provided around-the-clock care from medical and psychiatric experts.
"This landmark victory has created a legal precedent in California, lending support in the daily battles in treatment centers across the nation as they try to help patients access treatment using their insurance coverage," said Bonnie Harken, Managing Director of the International Association of Eating Disorder Professionals (iaedp) Foundation.
"The International Association of Eating Disorders Professionals (iaedp) Foundation participated in this legal battle by writing an Amicus Letter supporting residential treatment. Congratulations and our gratitude to Attorney Lisa Kantor and her team for their dedication and excellent legal representation in this major victory for the field of eating disorders and the millions who suffer and are denied an entire level of effective treatment by their insurers."
The California Mental Health Parity Act requires insurance companies to provide coverage for the treatment of severe mental illnesses, including anorexia and bulimia, on the same terms and conditions as it does for physical illnesses. "By offering longer lengths of stay, residential treatment provides a necessary component in the continuum of care. Many patients are not able to access this length of stay because of restrictions in their insurance plans," Harken said.
"Residential generally refers to the licensing status of a facility and is not a reliable indicator of the intensity of care or the professional and clinical licensing of the facility staff. A stay in a residential facility that provides 24-hour supervision including medical and psychological services with lengths of stays longer than a traditional hospital setting often plays a crucial role in the successful treatment of an eating disorder," added Harken.
"Some insurance companies that provide behavioral health benefits provide coverage for residential treatment. Blue Shield is one of the insurers who exclude such treatment while providing coverage for all other levels of care. The determining issue should always be the level of care services not the licensing of a facility. "
Attorney Lisa Kantor praised the broad nature of the opinion, saying Blue Shield has interpreted the statute too narrowly in the past. According to Kantor, Harlick's condition became so debilitating that she lost her job, and with it, her health insurance.
She hopes to pay for more treatment with the earnings from the lawsuit. "Jeanene's a warrior, and her determination to find a way to regain her health became a fight that is going to help so many people," said Kantor. "Even though she may not be the biggest beneficiary of her own legal battle, she is gratified that her struggle will allow others access to timely and effective treatment."
Since 1999, the California Mental Health Parity law has required insurers to cover treatment of mental health illnesses to the same degree that physical ailments are covered.
The illnesses that must be covered are schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, eating disorders, autism or pervasive developmental disorder, and serious emotional disturbances in children and adolescents.