Another Victory for Mental Health Coverage

Last month, the United States Court of Appeals upheld an August 2011 appellate decision that insurers in California must pay for residential treatment for eating disorders. In 1999, California implemented the mental health parity act, which was passed at the federal level in 2003, requiring that mental health benefits be covered under the same terms and conditions as medical benefits. Despite the passing of this act, many insurance companies continue to deny coverage for residential treatment for eating disorders, which can cost upwards of $1,000 per day. This decision was the first to determine that the phrase “same terms and conditions” included financial terms.

The decision was upheld in Harlick vs. Blue Shield of California. Harlick has suffered from anorexia nervosa for more than 20 years. In 2006, she sought treatment at a residential facility. However, Blue Shield refused to cover her nine-month stay, claiming that the residential facility was “assisted living care,” for which her insurance plan did not provide coverage. Initially, Harlick lost the case. However, she was victorious in her appeal. The court of appeals ruled that Harlick’s care was covered under the mental health parity act and that California insurance plans are obligated to pay for residential treatment of eating disorders—even if the policy excluded residential treatment—as residential treatment can be a “medical necessity” for eating disorder treatment.

This is yet another significant victory for those of us raising our voices to get equal coverage for eating disorders and other mental illnesses. Patients with a mental illness are often discriminated against by insurance providers and unable to obtain the care necessary for recovery. Hopefully decisions like Harlick vs. Blue Shield of California will help turn the tide. Recovery from an eating disorder is entirely possible, but appropriate treatment adequately covered by insurance is a vital component of recovery.

By: Dr. Jessica Baker