Eating Disorder Ruling Sparks Debate Over Mental Health Parity
Physicians, insurers and patient advocates are monitoring the effects of a federal court ruling that California insurers must cover residential treatment for mental health conditions such as anorexia, the New York Times reports.
The ruling has led to increased debate about the boundaries of health insurance coverage for mental health conditions.
In August, the 9th U.S. Circuit Court of Appeals in San Francisco ruled that the state's Mental Health Parity Act requires health insurers to provide the same coverage for severe mental health conditions as for physical conditions, even if there was no exact physical ailment equivalent (Pollack, New York Times, 10/13).
The ruling stemmed from a case involving Blue Shield of California and a policyholder's anorexia treatment (California Healthline, 9/6).
Some experts say the ruling could have implications for agencies, courts and insurers outside California.
Supporting the Treatment
Patient advocates and physicians contend that residential treatment of eating disorders is essential.
They say that while hospitalization could stabilize a patient and assist with weight gain, it generally does not treat underlying psychological issues.
They note that although outpatient treatment might be covered by insurers, it does not provide 24-hour counseling.
Opposing the Treatment
Health insurers argue that residential treatment is costly and that its effectiveness is unproven. They also say residential treatment is more of an educational than medical service.
Jena Estes -- vice president for the BlueCross and BlueShield Association's federal employee program -- said there is a "wide variation in licensing across the country" for the treatment, as well as a lack of oversight of many residential treatment centers.
In addition, some insurers say that the treatment does not have to be covered under mental health parity laws because there is no treatment for physical ailments that is equivalent to residential programs for mental health conditions.
Blue Shield Weighs In
Blue Shield is seeking to have the case reheard, arguing that the ruling could raise costs by forcing insurers to pay for mental health treatments with no clear limits. Residential treatment can cost more than $1,000 daily.
The insurer added that offering better coverage for mental health conditions than physical ailments would violate mental health parity rules (New York Times, 10/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.