Insurance Companies Refuse To Pay For Eating Disorder Treatment

Illustration for article titled Insurance Companies Refuse To Pay For Eating Disorder Treatment

According to Republicans, it's of the utmost importance that we challenge any efforts to reform healthcare in America. If you still don't understand why, here's the latest example of how the great, nay, greatest healthcare system in the world functions: Insurance companies are fighting to exclude residential treatment for eating disorders from coverage. After all, people who have mental disorders aren't really sick, they're just looking to get a payout because their brain tells them to do things that lead to serious health problems.

The New York Times reports that recently more insurance companies have been reaffirming that residential treatment for people with eating disorders and other mental conditions won't be covered. Some have even gone to court over the issue. In August, the United States Court of Appeals for the Ninth Circuit ruled that under California's mental health parity law, which requires that coverage for mental and behavioral disorders be equivalent to what's offered for physical conditions, insurance companies must pay for eating disorder treatments. There are similar laws in many states and on the federal level, but now insurers are sqabbling over the meaning of "equivalent."

The companies claim that residential treatment, which can cost $1,000 a day, shouldn't be covered because it doesn't quite match anything offered for physical health problems. In a case brought by Jeanene Harlick, who has anorexia, against Blue Shield of California, the Ninth Circuit Appeals judges ruled that the important factor is that residential treatment is medically necessary for some eating disorder patients. The judges wrote:

"Some medically necessary treatments for severe mental illness have no analog in treatments for physical illnesses ... For example, it makes no sense in a case such as Harlick's to pay for 100 days in a skilled nursing facility - which cannot effectively treat her anorexia nervosa - but not to pay for time in a residential treatment facility that specializes in treating eating disorders."

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Eating disorders have the highest fatality rate of any psychiatric disorder, and advocates say residential treatment is livesaving for some patients. Insurers counter that there aren't enough studies that prove this, and the facilities are more like education than medicine. While they bicker over the differences in treatment for mental and physical disorders, people who succumb to anorexia are just as dead as those who lose their fight with cancer.

Eating Disorders A New Front In Insurance Fight [NYT]

Image via Keith A Frith/Shutterstock.

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DISCUSSION

As someone who lived in Canada for most of my life, take it from me, if you are at least lower-middle class and up, you have a much better healthcare system.

I'd rather not wait 3+ months for a free MRI or scan for my knee to see if I have an ACL or MCL tear, when I can do a $20 co-pay and have it done in a week. And this is my own personal experiences.

The majority of our emergency rooms in Canada are filled with either drug addicts needing help they usually cannot provide, or people going in for free Tylenol-3 by saying they have migraines etc. But this is something Americans don't hear about. How about a 2-hour wait for emergency room beds in most of BC, especially Vancouver? It's good that we don't really have to worry about paying when we need to, or for major surgery etc. But I still pay the same in Washington for my healthcare plan, that I paid in BC.

Once again, my own personal experience, but people make it seem like Canada has this amazing healthcare system where you can get anything done and never have to pay etc. and it's just not true. Another thing to say is, the quality of Canadian ppublic healthcare is far behind what you get in america. It's getting so bad, that private clinics have started sprouting up in Vancouver.