When Jeanene Harlick's weight dropped to 65 percent of normal, her doctors recommended the San Mateo woman go into an intensive residential treatment facility that specialized in treating anorexia and other eating disorders.
But her health insurer, Blue Shield of California, refused to cover her care - not because it wasn't considered medically necessary, but because her plan excluded coverage for residential treatment programs. Harlick spent almost 10 months in residential treatment, while her parents went hundreds of thousands of dollars into debt to cover the cost.
Harlick, now 37, later sued the insurer.
Getting treatment covered for eating disorders has long been a struggle for many of the 24 million Americans diagnosed with anorexia, bulimia and binge-eating disorder. Intensive residential treatment for eating disorders typically costs $900 to $1,200 per day.
In a significant ruling for those seeking residential treatment for mental health conditions, the Ninth Circuit Court of Appeals in San Francisco sided with Harlick last month. The three-judge panel ruled Blue Shield's policy excluding residential treatment violates the state's 2000 Mental Health Parity Law, which requires certain serious mental health diagnoses, including eating disorders, to be covered at the same level as physical health.
"It's a landmark victory for those suffering with eating disorders," said Lara Gregorio, legislative policy program director for the National Eating Disorders Association. "So many families go bankrupt fighting this and still don't win. It sets a precedent for other states to follow suit."But the legal battle is not over. On Friday, Blue Shield, which is based in San Francisco, filed a petition for a rehearing in front of the same appellate court panel. A lower court had ruled in favor of the insurer.
Blue Shield spokesman Stephen Shivinsky said the petition is based on "several significant errors in the opinion." According to court documents filed Friday, the insurer argued that state law does not require coverage for all medically necessary treatments and allows plans to set coverage limits.
Harlick's attorney, Lisa Kantor, described the appeal as "desperate" and is convinced the appellate court decision will prevail.
"The point of this decision is (insurers) have to provide all medically necessary treatments for severe mental illnesses," Kantor said. "When you exclude a critical modality of treatment such a residential treatment, you're not providing parity."
California has one of the strongest mental health parity laws in the country, but some argue that anorexia and other mental health conditions are still not treated as comprehensively as physical health, often because they are misunderstood.
While many patients with eating disorders can be treated on an outpatient basis, some patients need hospitalization or the constant supervision of a residential treatment center.
"Residential treatment is a key component of working on eating disorders," said Victoria Green, clinical director of New Dawn Eating Disorders Recovery Centers, which has a residential treatment center in San Francisco.
"You have hospitalization, which only stabilizes somebody medically, and we're the next level of treatment. We treat highly acute people who cannot function in the world," she said, adding that insurers either don't cover the care or authorize just a few days of treatment at a time.
Dr. Neal Anzai, medical director of the eating disorders program at Alta Bates Summit Medical Center in Berkeley, said his patients have to be "literally on the verge of death" to get hospitalized and then their insurance coverage often dictates how much care or what kind of care comes next."It's hard to get people into the hospital, but once they're there, there's a battle whether we can get them down to residential care or partial hospitalization," he said.
In Harlick's case, her insurer would cover hospitalization but not residential care.
Harlick had been battling anorexia and obsessive-compulsive disorder for more than 20 years when her doctors recommended a residential center in 2006. Harlick finally found a suitable inpatient facility in Missouri, where she stayed almost 10 months - from April 2006 to January 2007.
"The treatment I received helped me have a lot more compassion for myself. I do still struggle and am still working on it," said Harlick, who continues to battle with issues of weight and is on disability, but is working to finish her master's in social work at San Francisco State University.
"I'll keep on fighting, but I know if I haven't received the treatment I did, I would most likely be dead," she said.
Harlick said she wants her case to be successful to help other people receive the treatment they need. She also hopes it will legitimize anorexia as a mental illness, and not an obsession with weight and appearance as some people believe.
"It would just be extremely rewarding to think something a little good came out from my struggle because I still feel enormous guilt and shame," said Harlick, referring to her continuing condition as well as the unspecified amount of money her family spent for her treatment.
For Harlick's mother, Robin Watson, the money was the last thing on her mind."We were so desperate, we thought we were going to lose our daughter," said Watson, who lives in Burlingame. "We had to move and deal with the consequences later."
While Watson hopes to recoup the treatment costs, she said the three-year court battle has become about more than money. "It's about the discrimination insurance companies put on mental illnesses and the very little understanding they have about eating disorders," she said.
Kantor, Harlick's attorney, filed a petition last week in state Superior Court in Los Angeles for a class-action suit against Blue Shield on similar grounds.
"Jeanene was lucky. Her family knew they needed to take care of her," Kantor said. "I'm scared to find out what will happen to a lot of young women who had this policy and didn't have a family to support them. I don't know how many lives we've lost."
***-- Anorexia is characterized by self-starvation and weight loss. Binge eating and bulimia can involve behaviors such as vomiting, use of laxatives and excessive exercise.
-- More than 90 percent of sufferers are female, with most being diagnosed as teenagers.
-- Anorexia nervosa has the highest mortality rate of all mental health diagnoses.
-- Health effects include fatigue, blood pressure problems, osteoporosis, electrolyte and chemical imbalances, and death.
-- Twenty-three states, including California, have enacted mental health parity laws that require insurers to cover eating disorders, but coverage requirements vary greatly.
Source: National Eating Disorders Association.
