Former Client Wins Battle with Insurance Company
In August, the California Ninth Circuit Appeals judges, ruled that residential treatment was medically necessary for eating disorders, and therefore had to be covered under the state’s parity law, even if no exact equivalent existed on the physical disease side.
“Some medically necessary treatments for severe mental illness have no analog in treatments for physical illnesses,” the three-judge panel wrote. “For example, it makes no sense in a case such as Harlick’s to pay for 100 days in a skilled nursing facility — which cannot effectively treat her anorexia nervosa — but not to pay for time in a residential treatment facility that specializes in treating eating disorders.”
This case involves Jeanene Harlick, a 37-year-old woman from California who has suffered from anorexia for more than 20 years. In 2006, she began intensive outpatient treatment, but her doctors said she needed a higher level of care, according to the written decision from the U.S. 9th Circuit Court of Appeals.
Her insurance company, Blue Shield of California, told her that residential treatment wasn’t covered under her plan, but that hospitalization would be covered if it was medically necessary, and the insurer gave her several names of potential hospitals. Her doctors determined none of those places could provide effective treatment and she admitted to Residential Treatment at Alsana Treatment Center.
Harlick received treatment at Alsana for more than nine months, and Blue Shield refused to cover her treatment costs, informing her that her insurance plan covers inpatient services in connection with a hospitalization, but doesn’t cover residential treatment.
Harlick filed a complaint in federal district court in 2008, but the court sided with Blue Shield and concluded that Harlick’s insurance plan “unambiguously excluded coverage for residential care.”
Harlick appealed the decision, and a three-judge panel of the U.S. 9th Circuit Court of Appeals sided with Harlick, ruling that Blue Cross’ denial violated California’s mental health parity law in denying her claim. The state’s parity law, which was enacted in 1999, requires that insurance plans provide the same coverage for “medically necessary treatment of severe mental illness” as they do for illnesses that are physical in nature.
Lisa Kantor of Kantor & Kantor law firm represented Harlick in this case. Kantor & Kantor has developed a specialized legal practice representing clients whose claims for treatment of eating disorders, and dual diagnosis (substance abuse and other co-morbid conditions) have been unfairly denied by their health insurers or benefit plan. Kantor & Kantor’s aggressive approach to litigation and legislation has brought justice for clients who have found themselves fighting for their insurance benefits when benefits were wrongfully denied.
At Alsana we are committed to providing quality Residential care. We believe that Residential treatment is optimal for many clients since it has the unique capacity to treat medical and physical complications while treating the underlying psychological issues. We applaud Harlick and Kantor & Kantor as they fight to create equality within healthcare and treatment for eating disorders.
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