Federal Appeals Court Rules Insurer Must Pay for Anorexia Treatment
A federal appeals court has ordered Blue Shield of California to pay for a policyholder's anorexia treatment, saying the treatment falls under provisions of California's Mental Health Parity Act of 1999, the Los Angeles Times reports (Williams, Los Angeles Times, 8/28).
The ruling could affect how health plans cover treatment for mental illnesses in states that have mental health care parity laws, according to MedPage Today (Walker, MedPage Today, 8/30).
Details of the Ruling
On Aug. 26, a panel of three judges from the 9th U.S. Circuit Court of Appeals in San Francisco said the Mental Health Parity Act requires health insurers to provide the same coverage for severe mental health conditions as for physical conditions (Los Angeles Times, 8/28).
The judges said all health plans within the scope of the act must cover medically necessary treatments for nine mental health conditions:
- Autism or pervasive developmental disorder;
- Bipolar disorder;
- Eating disorders;
- Major depression;
- Obsessive-compulsive disorder;
- Panic disorder;
- Schizoaffective disorder;
- Schizophrenia; and
- Serious emotional disturbances in children and adolescents.
The court ordered Blue Shield to pay for the policyholder's nearly 10-month anorexia treatment at a residential care facility, even though her policy did not include the coverage.
The decision overturns a lower court's ruling in the case (Tayefe Mohajer, AP/San Francisco Chronicle, 8/26).
Blue Shield's Response
Steve Shivinsky, vice president for corporate communications at Blue Shield, said the insurer was reviewing the appeals court ruling. He could not say yet what implications the ruling could have for the insurer's 3.4 million California policyholders.
Blue Shield could seek a full 11-judge rehearing or petition the U.S. Supreme Court to review the case (Los Angeles Times, 8/28).
The AP/KPCC's "KPCC News" reported on the appeals court ruling on health insurers' coverage of mental health conditions ("KPCC News," AP/KPCC, 8/26).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.