You have a life-threatening illness–the highest death of rate of any mental health diagnosis. Higher than schizophrenia, major depression, bipolar disease. Your doctors recommend residential treatment, which is expensive but a lot less than hospitalization.
Your insurance company says no.
When this happens to patients battling severe anorexia, or to their parents or spouses, most of us cave. We pay what we can, go into debt, try a treatment that is covered but doesn't work, pray. Jeanene Harlick had the gumption to sue. At the end of August, she won a landmark victory against Blue Shield of California.
Harlick's insurance must cover mental illness at the same level it covers physical illness.
For those of us who've been down this rabbit hole, what's the difference? If you're sick, you're sick. You need treatment.
More importantly for the Ninth Circuit Court of Appeals, Blue Shield was wrong to deny Harlick's claim because, under the California Mental Health Parity Act:
Every health care service plan contract issued, amended, or renewed on or after July 1, 2000, that provides hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age.
The law lists nine specific "severe mental illnesses" for which coverage for "medically necessary treatment" is required, including anorexia, and requires that plans cover treatment for mental and physical illnesses "under the same terms and conditions."
That is, if the insurance plan covers residential care for physical illness, it must also for the specified mental illnesses. http://www.leagle.com/xmlResult.aspx?page=2&xmldoc=In%20FCO%20201...
When Jeanene Harlick's weight dropped to 65 percent of normal, her doctors recommended that she go into an intensive residential treatment facility that specialized in treating anorexia and other eating disorders. Her insurance covered hospitalization but not residential treatment.
My family has been down that rabbit hole. Lisa was hospitalized for six weeks and came out with more severe anorexia than when she was admitted. Insurance paid the enormous hospital bill. When she got out, we paid for the out-of-network therapist who finally helped Lisa get on the road to recovery -- and out of the hospital.
Harlick's parents amassed hundreds of thousands of dollars in debt to pay for the residential treatment at the Castlewood Treatment Center in Missouri, where she stayed 10 months. Their daughter was dying. Was there a choice? Later, Harlick, now 37, sued Blue Shield. A three-year court battle ensued.
Last month, the court ruled: "Given that Harlick's doctors believed that outpatient treatment was insufficient, that Harlick entered Castlewood at 65% of her ideal body weight, and that Harlick needed a feeding tube while at Castlewood, it seems likely that more than outpatient treatment was indeed necessary."
In passing the parity act, the Legislature found that the discrepancy between physical and mental health in insurance coverage caused "relapse and untold suffering" for people with treatable mental illnesses, as well as increases in homelessness, increases in crime, and significant demands on the state budget.
Now of course, Blue Shield didn't fold its tents. The insurer immediately petitioned for a rehearing with the same three-member panel and with the full panel. But the ruling is law unless or until the panel decides to rehear it.
Meanwhile, Lisa Kantor, Harlick's attorney, filed a similar petition similar to Harlick's in Superior Court in Los Angeles on behalf of anorexic and bulimic patients.
As she told the San Francisco Chronicle, "Jeanene was lucky. Her family knew they needed to take care of her," Kantor said. "I'm scared to find out what will happen to a lot of young women who had this policy and didn't have a family to support them. I don't know how many lives we've lost." http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/09/09/MN8C1...
