A federal appeals court has ruled that Blue Shield of California must pay for a member's anorexia treatment because it was medically necessary and, therefore, required under the state Mental Health Parity Act. The ruling may lead to more insurers paying for mental illness treatment in states with strong mental health parity laws.
The case involves Jeanene Harlick, a Blue Shield of California member who suffers from anorexia. In 2006, her doctors said she needed inpatient treatment for her anorexia, but Blue Shield said residential treatment wasn't covered under her plan. It told her, however, it would cover hospitalization if it was medically necessary, and provided her with several names of potential hospitals. Her doctors determined none of those places could provide effective treatment so she registered at an inpatient treatment facility in Missouri, according to the Associated Press.
But the state Mental Health Parity Act requires that insurers provide the same coverage for mental disorders, including eating disorders, schizophrenia, schizo-affective disorder, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, and autism, as they do for physical ailments, the Los Angeles Times reports.
Since the U.S. 9th Circuit Court of Appeals ruled that Harlick's care at the residential facility was medically necessary, Blue Shield should have covered it, according to MedPage Today. "Given that Harlick's doctors believed that outpatient treatment was insufficient, that Harlick entered Castlewood at 65 percent of her ideal body weight, and that Harlick needed a feeding tube while at Castlewood, it seems likely that more than outpatient treatment was indeed necessary," the judges wrote in their opinion.
Steve Shivinsky, Blue Shield of California vice president for corporate communications, said the company was still reviewing the ruling and couldn't yet say what consequences it could have, notes the LA Times. Blue Shield could petition the court for a full 11-judge rehearing of the case or ask the Supreme Court to review it.
To learn more:
- read the appeals court opinion (.pdf)
- read the Los Angeles Times article
- see the Associated Press article
- check out the MedPage Today article
Share this on Twitter
Mental Health Parity law takes effect, cost effects unknown
Insurers criticized for preventing psychiatric care
BCBS of Illinois drops mental health pre-approval
Treat depression to improve diabetic outcomes