“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.”
In Blue Shield’s request for a rehearing, it argued that the decision would require insurers to pay for treatment of mental (conditions) “without substantive limits.” That would mean better coverage for mental illnesses than for physical illnesses, which would be inconsistent with parity, the (company) said, adding that it would also increase costs “to the point where some employers may simply forgo offering plans to their employees.” Even if policies cover residential treatment, an insurer could still (deny) reimbursement on the ground that the treatment is not medically necessary for a particular patient.
Katie Bird of St. Paul sought residential treatment last year, saying she had been exercising vigorously while (consuming) no more than a single hot chocolate on some days. As a result, she said, she experienced heart palpitations and frequently passed out while trying to care for her 3-year-old daughter.
She said her insurer, United Behavioral Health, would not pay the $200,000 it cost for her four months of (residential) treatment because her weight was not low enough. She sued and reached a confidential settlement.
It is still unclear how much money Ms. Harlick and her parents will recover from Blue Shield.
Ms. Harlick, who lost her job and (insurance) and is now on disability while studying social work in graduate school, said she hoped the court decision would show people that eating (disorders) were not just matters of weight and appearance, but serious diseases.
“I just feel like this ruling gives a little more legitimacy to the reality of what this illness is,” she said.
