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National NOW Times >> Winter 2007  >> Article

Insurance Companies Label Eating Disorders "Behavioral Illnesses," Refuse to Cover Mental Health Costs

By Holly Anne Manning, Publications Coordinator

According to the National Institute of Mental Health and The New England Journal of Medicine, an estimated five to 10 million people suffer from eating disorders in the U.S. — 90 percent are young women. Surprisingly, most states do not require insurance companies to cover the cost of mental health services for patients with eating disorders.

"So many young women are affected by anorexia, bulimia and binge-eating disorders," said NOW President Kim Gandy, "but we have yet to see any federal regulations requiring insurance coverage for their treatment. Without federal oversight, insurance companies hold all of the decision-making power, and they are using it to deny coverage for disorders that primarily affect women."

Dr. Thomas R. Insel, Director of the National Institute of Mental Health, confirms that anorexia is a "brain disorder" that can be cured with appropriate mental and physical treatments. But insurance companies argue that there are no "standards" prescribed for the treatment of eating disorders and that this lack of medical protocol gives them the authority to determine whether or not a recommended treatment is medically prudent.

Typically, insurance companies cover the cost of treating the physical symptoms such as heart failure, kidney failure, rupture of the esophagus, ulcers and high blood pressure. But treatments that address the mental health of the patient, and the root causes of the disorder, are not generally covered, or are only partially covered.

If anorexia, bulimia and binge-eating disorders are not treated early, they often progress until the physical effects are too disabling for a full recovery. At that point, many sufferers require the most dire and expensive medical treatments. Dealing first with the underlying problem — the eating disorder itself — would increase the likelihood of recovery and could actually be more cost-effective for insurance companies.

"Insurance companies run eating disorder patients and their families through the reimbursement wringer," says Gandy. "They force families to enter an exhaustive appeal process, averting their full energies from the well-being of their loved ones."

Most physicians recommend many more treatment sessions (the American Psychological Association suggests 40) than the average insurance company will cover (about 15) for patients to recover from their disorder. Some insurers only pay this much after the claims have been through an extensive appeal process, and even plans that cover inpatient treatment don't cover facilities that are out-of-state and therefore not "in network," which is problematic because many states lack centers that target treatment for eating disorders. Insurance companies consider an eating disorder more "severe" by the number of times it recurs, but the absence of early mental treatment frequently leads to relapse.

Eating disorders are not under the protection of the Mental Health Parity Act of 1996 because the legislation allows insurance companies to determine the length of coverage for inpatient and outpatient mental health treatments. The 109th Congress failed to pass the Mental Health Equitable Treatment Act, which would have required insurance companies to treat mental and physical illnesses the same way. But even that legislation did not define eating disorders as a mental illness, and would have allowed insurance companies to claim eating disorders as behavioral, not mental health conditions.

"Eating disorders are not a behavioral choice, but a treatable mental illness," said Gandy, "and Congress should require equitable coverage so that women receive the care they deserve on a national scale."

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