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Insurers must cover mental illness on par with physical, court rules

August 26, 2011 |  4:39 pm

Healthcare insurers must provide benefits to those with mental illnesses equal to those for clients with physical afflictions, a federal appeals court ruled Friday in a case that could lead to more extensive coverage for a wide array of disorders.

A Northern California woman's treatment for anorexia at a residential facility was medically necessary and must be paid for by her insurer, Blue Shield of California, a three-judge panel of the U.S. 9th Circuit Court of Appeals ruled.

Jeanene Harlick's policy specifically excluded coverage for residential treatment, the room and board expenses she incurred while at the Castlewood Treatment Center in Missouri for 10 months beginning in April 2006. But, the court said, the 1999 Mental Health Parity Act requires insurers to provide coverage of all medically necessary treatment for nine severe mental disorders, including eating disorders.

Harlick, 37, has struggled with anorexia for 20 years and had fallen below 65% of her ideal weight when her doctors recommended the Missouri residential program, the court noted. 

Blue Shield spokesman Steve Shivinsky said company executives were still reviewing the ruling and couldn't say what consequences it could have for the insurer or its 3.4 million California policyholders.

Harlick's attorney, Lisa Kantor, who specializes in advocating for clients denied coverage for eating disorders, said the 9th Circuit ruling could have broad implications for those with mental afflictions, including children with autism and Asperger's syndrome. 

The ruling may not have an immediate effect because Blue Shield has the option of appealing for a rehearing by a larger panel of the 9th Circuit or for U.S. Supreme Court review.


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