Earlier this year, a Robbinsville, New Jersey family won a landmark lawsuit against the Aetna Insurance Company due to the insurer's denial of claims to treat a 16-year-old adolescent girl with anorexia. The insurance company cut off coverage for the daughter of Robbinsville's Jeff Meiskin even though she required months of in-patient care. Aetna said her illness was a "non-biologically based mental illness" and limited her coverage to 20 outpatient visits per calendar year and 30 days of in-patient benefits.
Meskin's daughter was not the first to have her claims denied by an insurance company. She was not the tenth, or the hundredth. She was one of perhaps tens of thousands.
Limitations on access to care for eating disorders patients have not only historically posed a barrier to the recovery process for countless individuals, the restrictions have arguably put many lives at risk. The long-standing discrimination by insurance companies against patients suffering from psychological and behavioral disorders has led to higher co-payments, deductibles, and stricter limits on treatment for addiction and mental illness, leaving many patients and their families without care, without proper treatment, and in many cases, without hope.
That is until now...
A recent landmark decision by the U.S. government promises to remedy the unfair and dangerous practice of insurance discrimination against patients with eating disorders and other serious mental illnesses.The new " mental health parity law", which was passed by Congress in October, 2008, makes it illegal for health insurance companies to withhold coverage from patients suffering from psychological or behavioral disorders. Under the new law,
health insurance companies will be required to provide equal coverage of mental and physical illnesses. This equivalence, or “parity”, in insurance coverage will make it easier for people to obtain treatment for a wide range of mental health conditions, including eating disorders.
The law, known in Congress as the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008, requires health insurance companies nationwide to provide coverage for mental health treatment on an equal basis with medical care. Fora summary of the new mental health parity law, click here .
In order to better understand the impact that these changes will have on your professional healthcare practice, or for your family, I include below a Questions and Answer Fact Sheet regarding mental health parity, provided by the American Psychological Association.
Prior to the Q&A, however, allow me to remind you that If you believe your insurance company is unfairly denying coverage for eating disorders treatment, you may wish to consult an attorney who may be able to negotiate coverage or address the payment of claims. It may seem like a drastic step, but when it comes to the unfair practice of insurance companies acting as a barrier to appropriate care, you may need help receiving the intervention your family needs. In addition, you should always keep a written record to document any correspondence you have with insurance companies regarding treatment authorization.
For help with insurance issues, t he National Eating Disorders Association has put together an “Eating Disorder Survival Guide,” a free and helpful resource that addresses insurance coverage issues, explains what to do if you have been denied coverage, and offers tips for fighting for appropriate care (A printable version is also available by clicking the "printable version" link on their web-page).
KEEP READING FOR A MENTAL HEALTH PARITY Q & A...