Anthem accused of illegally capping eating disorder coverage (PDF)

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Anthem Blue Cross faces a class action lawsuit filed earlier this month that accuses the health insurer of violating California law by illegally denying recommended care to PPO policy-holders who suffer from eating disorders. 

The lawsuit, filed Aug. 19 in Los Angeles County Superior Court alleges the insurer has violated several state laws by refusing to cover recommended treatments for eating disorders. 

"Under the California Mental Health Parity Act, people with severe mental illness are entitled to the same care and treatment as people who have just physical illness," says Kathryn Trepinski, the Beverly Hills lawyer representing  the class action's named plaintiff, Shelby Oppel, 24, of Pasadena.

In the complaint, Oppel says she sought treatment for the eating disorder "bulimia nervosa," which is characterized by binge eating, followed by vomiting or excess laxative use to purge the food. Bulimia is among the eating disorders classified as a "severe" mental illness by the California Mental Health Parity Act of 1999. 

The complaint alleges that Anthem's guidelines for treating eating disorders rely on outmoded psychiatric protocols as a way to save the company money. It also accuses Anthem of illegally discriminating against those with eating disorders and  interfering with the professional judgment of doctors, in violation of the state’s Medical Practices Act.

"We cannot comment on the complaint specifically, but Anthem's mental health protocols are lawful and appropriate," Darrel Ng, Anthem spokesman said in a written statement. "In addition, should there be a dispute about the medical necessity of any treatment, every Anthem member is entitled to an independent medical review overseen by state regulators."

The lawsuit seeks $4,000 for each PPO policy holder who, since 2009, sought and was denied full treatment from Anthem for an eating disorder. Read the full complaint below. 

Class Action Complaint

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