Newspaper article

Eating-Disorder Patients Fight Double Battle: Their Disorder, and Insurance Firms

Newspaper article

Eating-Disorder Patients Fight Double Battle: Their Disorder, and Insurance Firms

Article excerpt

Katie Bird had been battling an eating disorder ever since she started taking diet pills at age 13.

When she had a child of her own, she knew she couldn't keep passing out from lack of calories; she needed to win the fight. But she didn't realize she'd also need to battle her insurance company to do it.

By virtue of living in Minnesota, Bird was actually luckier than many with eating disorders: Patients come from all over the Midwest to take advantage of Minnesota's clinics, therapy and residential programs. The Emily Program, which opened here in 1993, has grown into one of the largest eating-disorder treatment facilities in the country; founder Dr. Dirk Miller recently won two awards for his work from the University of Minnesota.

Minnesota Sens. Amy Klobuchar and Al Franken are both sponsors of the Federal Response to Eliminate Eating Disorders Act (S. 481, called the FREED Act), a bill designed to increase funding for research, treatment, education and prevention of eating disorders. And Rep. Keith Ellison is a sponsor of the House version, HR 1448.

Minnesota is even referred to as the "Disneyland" of treatment because it's perceived to be easier to get insurance coverage here. Much of that can be credited to former Minnesota Attorney General Mike Hatch, who sued Blue Cross and won an $8.2 million settlement in 2001.

Hatch contended in the suit that the company denied adequate treatment to eating-disorder patients, including 21-year-old Anna Westin, who committed suicide after a long fight with anorexia. (Today marks the 12th anniversary of Anna Westin's death after a long battle with anorexia, and February is Eating Disorder Awareness month.)

Even here, many lack full coverage

Still, The Emily Program estimates that roughly 10-15 percent of clients get denied full coverage from their insurers, according to spokeswoman Kari Fox.

That's led to a trend toward more lawsuits, said St. Paul attorney Elizabeth Wrobel, who has worked on over a dozen eating- disorder cases since 2009.

"At the end of the day, the insurance company is only liable for the benefits, the attorney's fees, and interest," Wrobel said."It's unfortunate, but from my perspective, there's not a lot of disincentive for insurers to deny claims."

Many patients who are denied coverage simply stop seeking treatment, Wrobel said, or pay for it themselves and don't seek reimbursement. Most never get to the point of seeking legal help.

"A lot of people who are denied coverage aren't necessarily in a place mentally to push back," she said.

For those who do, Wrobel's involvement can range from a phone call to the insurance company, which sometimes sparks immediate authorization of treatment, to filing a lawsuit.

Hallie Espel lobbied in Washington, D.C., last fall in large part because she saw so many of her peers going through the double- battle.

"When people are discharged it's because your insurance company says you're done, rather than the doctors saying you're ready," Espel said. "More often the case than not, these people are not getting the treatment they need."

Residential treatment often denied

Espel says her stay at the Anna Westin House, a residential house that's part of the Emily program, was essential to her recovery, but it's often residential treatment that insurance companies deny. (She herself feels lucky to have had limited insurance issues during her 9-year battle with an eating disorder.)

Few studies have been done on the effectiveness of residential treatment. Psychiatrist Dr. Murray Zucker, western regional medical director for behavioral health at OptumHealth Behavioral Solutions (the new name for United Behavioral Health) said focusing on the outcome of patient care is essential.

"We hear this a lot from parents: We're all tired of going to facilities where our children are not getting better," he said. "Can't you tell us what is the best? …

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