All insurance carriers or health benefit
plans in Missouri would be affected.
Reprinted from Eating Disorders Review
March/April Volume 24, Number 2
©2013 Gürze Books
Missouri State Senator David Pearce (R-Warrensburg) introduced a bill during a recent committee hearing that would mandate health insurance coverage for Missourians with eating disorders. If approved, eating disorders patients in Missouri with insurance would be covered for diagnosis and treatment of their eating disorder as well as for residential, medical, and psychiatric treatment.
HB 1509, the Health Insurance Coverage for Eating Disorders bill, would require all Missouri heath insurance carriers or health benefit plans that are issued, delivered, continued or renewed to provide coverage. It would also bar insurers from:
- Denying an eligible individual enrollment in or renewal of coverage solely to avoid providing coverage for the diagnosis and treatment of an eating disorder;
- Denying coverage for treatment of an eating disorder when it is medically necessary in accordance with the most recently published APA Practice Guidelines for the Treatment of Patients with Eating Disorders;
- Providing monetary incentives or other benefits to individuals to encourage them to accept less than the minimum coverage;
- Penalizing, reducing, or limiting provider reimbursements for services rendered for eating disorders treatment;
- Providing monetary or other incentives to a provider for not treating an individual with an eating disorder; or
- Denying an eligible individual enrollment in or renewal of coverage if the individual was previously found to have an eating disorder or to have received treatment for an eating disorder.
Senator Pearce testified that lack of adequate funding for comprehensive eating disorder coverage prevents 9 of 10 Americans with eating disorders from receiving treatment. The proposed bill would cap treatment funding at $30,000.
The breakthough case in California
A major breakthrough came in June, 2012, with a ruling by the United States Court of Appeals for the Ninth Circuit, San Francisco, that insurers in California must pay for residential treatment for eating disorders and other serious mental illness, under the state’s mental health parity plan (Harlick v. Blue Cross). The California case revolved around Jeanene Harlick, a patient with anorexia nervosa (AN) who received lifesaving treatment several years before at a residential facility in St. Louis. Harlick had battled AN for more than 20 years. When her condition worsened in 2006–despite intensive outpatient therapy–she checked into the Castlewood Treatment Center, St. Louis, MO, where a feeding tube was required to sufficiently increase her caloric intake.
Blue Shield of California refused to pay for Harlick’s 9-month stay at the treatment center, likening it to assisted living care, which her policy did not cover. Harlick first filed a complaint in federal district court in 2008. Her lawyers argued that undergoing residential treatment for AN is comparable to receiving care at a skilled nursing facility. In the first case, the court ruled for Blue Shield. Harlick appealed the decision, and was victorious. Blue Shield is already seeking to have the case re-heard, arguing that the decision could force insurers to pay for unlimited amounts of treatment, which would in turn raise insurance costs.