Blue Shield has been ordered by a California appeals court to pay for a policyholder's anorexia treatment. The decision calls on insurers to treat mental illness as they would physical ailments.
The 9th U.S. Circuit Court of Appeals on Friday said state law requires the insurer to pay for Jeanene Harlick's nearly 10-month treatment for anorexia at a residential care facility, though her plan didn't include the coverage.
In a statement, Blue Shield spokesman Stephen Shivinsky said the insurer is reviewing the decision and would not provide further comment. An appeal would need to petition the U.S. Supreme Court.
Since 1999, the California Mental Health Parity law has required insurers to cover treatment of mental health illnesses to the same degree that physical ailments are covered.
In its opinion, the three-judge panel found that all health plans within the scope of the act must provide coverage of medically necessary treatments for nine specific severe mental illnesses outlined by the law.
The illnesses that must be covered are: schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, eating disorders, autism or pervasive developmental disorder, and serious emotional disturbances in children and adolescents.
Harlick's lawyer Lisa Kantor praised the broad nature of the opinion, saying Blue Shield has interpreted the statute too narrowly in the past.
The 33-page opinion overturns a lower court decision dismissing Harlick's claim.
According to the opinion, Harlick's doctors told her in March 2006 that she needed a higher level of care than the intensive outpatient treatment she was receiving.
Anorexia nervosa is an eating disorder that causes people to obsess about their weight and attempt to maintain a weight that is far below normal. Endless bouts of excessive exercise and starvation have resulted in death in extreme cases.
Whereas Harlick's plan with Blue Shield would have covered a hospital stay for a physical ailment, when her mental illness required residential treatment, the insurer told her that treatment wasn't covered, according to the opinion.
Blue Shield advised Harlick of several facilities where she could be hospitalized, full- or part-time, but she and her doctors said none of the facilities the insurer suggested could provide effective treatment, the judges wrote.
When she checked in at Castlewood Treatment Center, a Missouri residential treatment facility that specializes in eating disorders, Harlick was at 65 percent of her ideal body weight.
Less than a month after checking in, a feeding tube was inserted to give her the calories she needed to survive. She stayed at Castlewood from April 17, 2006, until January 31, 2007.
Though the court sided with Blue Shield that Harlick's plan didn't cover residential treatment for her anorexia, they found that under the state's parity law, the insurer must provide for her care.
Harlick will be reimbursed for her care at Castlewood under the ruling — an as yet undetermined amount in the tens of thousands, said Kantor.
Harlick's condition became so debilitating that she lost her job, and with it her health insurance, said Kantor. She now relies on Medicare.
Harlick hopes to pay for more treatment with the earnings from the lawsuit, said Kantor
"Jeanene's a warrior and her struggle and her fight is going to help so many people," said Harlick. "Unfortunately she may not be the biggest beneficiary of her own legal battle."