Court Upholds Decision on Anorexia Treatment, Mental Health Parity

The court upheld its decision on coverage for anorexia (Flickr/Rega Photography)

A closely watched case testing California’s Mental Health Parity law has withstood a call for a rehearing.

The Courthouse News Service reports that this week the U.S. Ninth Circuit Court of Appeals upheld its decision from August 2011 requiring Blue Shield to cover one woman’s treatment for anorexia under state law, even though it wasn’t spelled out in her policy.

The 9th Circuit refused Monday to reconsider a ruling ordering Blue Shield of California to pay for a severely anorexic woman’s long stay in a residential treatment facility, despite a strong dissent by one judge.

A three-judge panel of the San Francisco-based federal appeals panel ruled last year that California’s mental-health parity law required Blue Shield to pay for Jeanene Harlick’s nine-month stay in Missouri’s Castlewood Treatment Center.

But the court did fiddle with one aspect of their original stance and reinterpreted some of the regulatory wording. While that didn’t change things for the majority, the dissenting judge, Judge N.R. Smith wrote, “despite this significant change in our textual interpretation, the majority remains convinced that our original interpretation of the Parity Act was still correct based on conflicting legislative history and ‘common sense.’ I see it differently and am surprised by the majority’s conclusion.”

Harlick’s attorney Lisa Kantor said the decision was only good news for her client. “This is going to have far reaching implications for anyone who suffers from a severe mental illness,” Kantor said. “Because the decisions clearly states that all medically necessary treatment must be covered for those who suffer from those enumerated mental illnesses.”

The National Eating Disorders Association also applauded the opinion. President Lynn Grefe said, “Patients have been discriminated against by insurers through the years, so we hope this ruling will help turn the tide.”

But in an emailed statement Blue Shield sounded a positive note:

Blue Shield of California is encouraged by the Ninth Circuit Court’s opinion in response to our petition challenging the Harlick decision. The new opinion corrected some of the errors that Blue Shield had pointed out in its Petition for Rehearing and includes a strong, well-reasoned dissent by Justice Smith, who supports Blue Shield’s understanding of the California Mental Health Parity Act.

The statement went on to say that the insurer is seriously considering filing a new petition for rehearing or asking for a full court review.

Attorney Lisa Kantor says people with mental illnesses and their families and advocates will be watching from around the country to what happens next. Kantor says Connecticut and Vermont have similar statutes and advocates for people with eating disorders are following the Harlick case, hoping they can get a similar court ruling.

Some observers say they expect this is a starting point, not an end point. And that the issue of how exactly parity will be defined and the types of services expected going forward will be a point of discussion for a long time.

California’s Mental Health Parity law was passed in 1999 and requires insurers to give patients equal coverage for certain mental health conditions as they would have for physical ailments. Some of those including major depression, panic disorder, autism and bipolar disorder.

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