EATING DISORDERS: HMOs Limiting Coverage
"The advent of managed care has cut treatment options for anorexics and bulimics, who sometimes require months of hospitalization," the AP/Contra Costa Times reports. Eating disorders are often "considered a mental illness" by health plans, which means coverage caps often apply. While a "$30,000 lifetime cap would cover less than 30 days of inpatient care," one physician "specializing in eating disorders" noted that anorexia "is a chronic illness that takes three to four years on average to effectively treat." The specialist, Dr. Hans Steiner of Stanford University's Eating Disorders Program at Lucile Packard Children's Health Services, said: "If you've got diabetes, no problem. If you've got anorexia -- big problem." The AP/Times notes that some HMOs have lifetime caps as low as $10,000 for mental health treatment.
State Assemblywoman Liz Figueroa (D-Fremont), the chair of the California Assembly's Committee on Insurance, "held a hearing earlier this year on HMO care for people with eating disorders after receiving complaints about inadequate coverage and limited access to specialists." Figueroa said the issue is "whether HMOs and insurers are doing all that is 'medically necessary' in terms of care as required by law." Eating disorders are "a growing issue at schools and universities throughout the United States. It's becoming a growing trend, not only with women, but now it's becoming a problem with all of our youth," she said. But Myra Snyder of the California Association of Health Plans "said it's more of more of an employer's problem, because they select health care plans for" their workers. "People think the health plans determine what to cover and what not to cover. We don't. It's the employers who decide," Snyder said. She also notes that "there are few places providing qualified care" for eating disorders, "which, coupled with the complexity of treatment, adds to patients' limited options." But Snyder added that "it would be more cost-effective for insurance providers to treat eating disorders early, before increased care and treatment is needed" (Peterson, 5/4).