How does the insurance industry categorize eating disorders and where do they draw the lines for treatment? Sometimes it is taking the action of a lawsuit to get changes made in how a policy will cover. In one case going before the courts in Los Angeles, a young woman with anorexia was released when the insurer cut of her benefits and she ultimately died. The term is called “medical necessity’ used when determining who gets coverage and who doesn’t and there are no guidelines or laws in place to regulate the findings and decisions of the insurers. BD
Answers are hard to come by because insurers deny or severely limit coverage for an eating disorder -- as with all mental illnesses -- based on a medical assessment process that is neither uniform throughout the industry nor transparent. So far, attempts to change this system have been successful only in a piecemeal fashion. The suicide of Anna Westin, 21, in 2000 after her insurer denied coverage for her anorexia led to a lawsuit against Blue Cross and Blue Shield of Minnesota. The suit, which was settled out of court, resulted in the company's redesign of its medical assessment procedure and, in turn, expanded access to care for members with eating disorders and other mental diseases. Earlier this month, Aetna settled a class-action suit over coverage for eating disorders, agreeing to pay $250,000 in reimbursements to as many as 100 New Jersey policyholders whose claims were denied.
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