By JESSICA BAKER
Published: February 4, 2014

As eating disorder mental health practitioners, we are all too familiar with the difficulty patients have in obtaining insurance coverage for their care. A problem I have frequently encountered is patients’ insurance not covering appointments with registered dietitians as part of eating disorder treatment. In contrast, individuals with conditions such as diabetes are often covered for unlimited nutritional counseling appointments. This discrepancy was true of one of the “big five” health insurance companies, CIGNA. CIGNA has approximately 11.4 million insurees in the United States and is ranked #129 on the Fortune 500 list, bringing in $30 billion in annual revenues. Since 2010, CIGNA has consistently denied nutritional counseling for mental health conditions, mostly for eating disorders, on the basis that the members exceeded the three visit limit placed on nutritional counseling for mental health conditions.

In 2010, an investigation was launched by the New York Attorney General’s Office into CIGNA’s admiration of mental health benefits after receiving a complaint from the family of a 14 year-old girl suffering from anorexia nervosa. The family claimed that CIGNA had improperly denied coverage for nutritional counseling necessary for her eating disorder treatment. Because of the limit of three visits per calendar year, CIGNA rejected the family’s request for coverage. Rather than jeopardize their daughter’s treatment, the family paid $2,400 out of pocket.

Recently, the Attorney General’s office has reached a settlement with CIGNA. The settlement requires CIGNA to comply with “Timothy’s Law,” a New York state law enacted in 2006, named after a 13 year-old boy who committed suicide after being denied ongoing mental health treatment and hospitalizations by the family’s insurance company. The law requires that New York group health plans provide “broad-based coverage for the diagnosis and treatment of mental, nervous or emotional disorders or ailments … at least equal to the coverage provided for other health conditions.” This law is similar to the federal Mental Health Parity and Addiction Equity Act, enacted in 2008, which requires health insurance companies to ensure that financial requirements and treatment limitations applicable to mental health are no more restrictive than the requirements and limitations applied to medical benefits. The restriction of three visits per calendar year versus unlimited nutritional visits for diabetes is a perfect example of a differential treatment limit placed on a mental health condition versus a “medical” condition, which is not permissible based on the Mental Health Parity and Addiction Equity Act.

Under the terms of the settlement, CIGNA will eliminate its three visit cap for nutrition counseling associated with mental health conditions and pay members whose claims were previously denied due to the limit. Further, CIGNA will pay penalties for the wrongful denial of these claims to the Attorney General’s Office.

This is a step in the right direction, but not enough. As I noted, I often see this type of coverage denied or limited for our eating disorder patients; even though nutritional counseling is often key to recovery. Visits with a registered dietitian help patients develop balanced meal plans and understand of the implications of low body weight and restrictive eating behaviors. For the 14 year-old girl who was denied coverage, she was ultimately able to reach a healthy body weight. It is unfortunate that CIGNA, and other insurances companies, limit this coverage. Not all families are able to pay the out of pocket costs for eating disorder treatment. We need to keep fighting the good fight and get more wins in the column for eating disorder treatment with insurance companies.

photo credit: marfis75 via Creative Commons

photo credit: floyduk via Creative Commons