California 9th Circuit Court of Appeal decision in Harlick - Mental Health Parity applies and Blue Shield must pay for residential treatment of eating disorder
The EDC applauds and commends Lisa Kantor, LLP for her huge victory in California! She represented Jeanene Harlick against Blue Shield who refused to pay for her residential treatment. The case was decided by the 9th Circuit Court of Appeal in California. The Court found that the California Mental Health Parity Act requires Blue Shield to pay for residential treatment for an eating disorder.
A few excerpts from the OPINION as follows:
W. FLETCHER, Circuit Judge:
Plaintiff Jeanene Harlick suffers from anorexia nervosa. The question before us is whether Blue Shield was required to pay for her care at a residential treatment facility, either under the terms of her insurance plan or under California’s Mental Health Parity Act. We conclude that her insurance plan does not so require, but that the Mental Health Parity Act does."
For the reasons that follow, we conclude that the Mental Health Parity Act requires that a plan within the scope of the Act provide all “medically necessary treatment” for “severe mental illnesses,” and that Harlick’s residential care at Castle- wood was medically necessary.
1. Overview of the Act
The California Mental Health Parity Act (“Parity Act” or “Act”) was enacted in 1999. In enacting the statute, the HARLICK v. BLUE SHIELD OF CALIFORNIA
California legislature found that “[m]ost private health insur- ance policies provide coverage for mental illness at levels far below coverage for other physical illnesses.” 1999 Cal. Legis. Serv. ch. 534 (A.B.88), § 1 (West). The legislature further found that coverage limitations had resulted in inadequate treatment of mental illnesses, causing “relapse and untold suf- fering” for people with treatable mental illnesses, as well as increases in homelessness, increases in crime, and significant demands on the state budget. Id.
To combat this disparity, the Parity Act provides, in perti- nent part:
(a) Every health care service plan contract issued, amended, or renewed on or after July 1, 2000, that provides hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age . . . under the same terms and con- ditions applied to other medical conditions as speci- fied in subdivision (c).
The EDC supported an Amicus Brief submitted by the International Association of Eating Disorders in support of residential treatment as a necessary step in the continuum of care. See the brief below.
IN THE UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT
MOTION BY EATING DISORDERS COALITION FOR RESEARCH, POLICY AND ACTION (“EDC”) FOR LEAVE TO JOIN BRIEF OF AMICUS CURIAE INTERNATIONAL ASSOCIATION OF EATING DISORDERS PROFESSIONALS (“IAEDP”) IN SUPPORT OF PLAINTIFF/APPELLANT AND REVERSAL OF THE UNDERLYING JUDGMENT
The Eating Disorders Coalition for Research, Policy and Action (“EDC”) respectfully moves this Court, pursuant to Federal Rule of Appellate Procedure 29, for leave to join the brief previously filed by amicus curiae International Association of Eating Disorders (“IAEDP”). (IAEDP’s motion for leave to file a brief was concurrently filed with its brief on November 1, 2010, and was referred
California (3:08-CV-03651-SCto the Court’s merits panel on November 17, 2010.) EDC does not wish to file its own separate brief; it only wishes to join the brief previously filed by IAEDP.
Like IAEDP, EDC is a non-profit organization committed to advancing the interests of those afflicted with eating disorders. EDC is comprised of more than thirty organizations, institutions, and programs, including IAEDP. EDC is primarily committed to encouraging the federal recognition of eating disorders as a public health priority. EDC endeavors to persuade Congress and other federal entities to (1) increase resources for research, education, prevention, and improved training; (2) promote federal support for improved access to care; (3) promote the national awareness of eating disorders as a public health problem; and (4) promote initiatives that support the healthy development of children.
Like IAEDP, EDC believes that eating disorders are a widespread, misunderstood, and often overlooked public health problem in the United States. Studies show that approximately eleven million Americans suffer from an eating disorder, nearly half of all Americans personally know someone with an eating disorder, and anorexia nervosa is the third most common chronic illness among adolescents.
Experts in the field of eating disorder treatment have determined that residential treatment is an essential part of the spectrum of appropriate medical care for those suffering from eating disorders. As a result, EDC believes that such care, like any medically necessary medical care, should be covered by insurance. EDC is concerned that the judgment in this case, if upheld by the Court, would inevitably result in decreased access to residential care by eating disorder patients. Such a result would not only endanger the health of patients, but also increase the total cost of treatment as those patients are forced to interrupt their care and change health care providers.
Thus, EDC, like IAEDP, contends that access to appropriate treatment, including residential care covered by insurance, is of critical importance not only to patients but to the health care system as a whole. As a result, EDC hereby seeks to join amicus curiae IAEDP’s brief in support of Plaintiff/Appellant’s brief to reverse the underlying judgment.
We want to hear from you: Join the Campaign to Hold Insurance Companies Accountable
The EDC will continue to partner with Lisa Kantor and other lawyers working to Hold Insurance Companies Accountable. Please join our campaign. If you have been denied residential treatment for eating disorders we want to hear from you. Email us at EDCHoldsInsuranceAccountable@yahoo.com