Insurers Pressed About Eating Disorders

With her weight dwindling to 95 pounds on her 5-foot-10 frame, Kathryn Bromfield decided she needed more than another trip to a hospital psychiatric ward to survive anorexia.

Her insurance company, however, wouldn’t pay for residential treatment at a center specializing in eating disorders. She turned to her parents, who mortgaged their house and used credit cards to pay more than $53,000 for 11 weeks of treatment.

“I felt guilty for asking my parents to pay for a place,” said Bromfield, a 22-year-old college student in Ann Arbor, Mich. “I was at a really fragile state.”

Advocates for victims of eating disorders hope a lawsuit settled recently in Minnesota will compel insurers throughout the country to pay for treatment for anorexia sufferers like Bromfield.

The lawsuit, filed by the state, involved a woman who was denied treatment for her eating disorder by Blue Cross & Blue Shield of Minnesota.

The woman, 21-year-old Anna Westin, committed suicide after suffering from anorexia for five years. Her family had covered her treatment costs, but sued Blue Cross for refusing to pay.

In June, Blue Cross agreed to a $1-million settlement with the family and agreed to begin accepting doctors’ recommendations for the treatment of eating disorders.

“We’ve failed these families,” Richard Neuner, a Blue Cross vice president, said in announcing the settlement.

The settlement does not apply to insurance companies in other states, but observers said it could lead to similar lawsuits and changes throughout the country.

“In every instance where inappropriate insurance coverage is brought to public attention, it evokes a better response on the part of insurance carriers to give adequate treatment to their patients,” said Christopher Athas, vice president of the National Assn. of Anorexia Nervosa and Associated Disorders.

Harry Sutton, an independent health care consultant in Edina, Minn., said he expects the settlement to affect other insurance companies and eventually other states. Minnesota’s other three major HMOs are already reviewing procedures for granting mental health treatment.

“The same pressure will come out everywhere else, but maybe not as violently as it did here,” Sutton said.

Bromfield’s insurer is Blue Cross & Blue Shield of Michigan. Spokeswoman Helen Stojic would not comment on Bromfield’s case.

Besides pressing for lawsuits, activists are pushing for federal legislation requiring insurers to pay to treat eating disorders and other mental illnesses. One supporter, Sen. Paul Wellstone (D-Minn.), said insurers currently cover only some mental illnesses and require higher co-payments and restrictions on the treatment of others.

“When you make those kinds of distinctions, all too often eating disorders get left out,” Wellstone said.

Patients’ rights plans offered by both parties would expand treatments health plans must offer. Patients also would have more ways to appeal decisions denying them coverage.

The insurance industry said such moves would raise the cost of premiums and could leave hundreds of thousands of people uninsured.

“Our problem with mandates is that this stuff is not free,” said Joe Luchok, spokesman for the Health Insurance Assn. of America. “Nothing happens in a vacuum.”

In Minnesota, Westin’s family said it will donate the settlement money to the state’s first residential treatment center for eating disorders.

“People need to be able to speak out and they need to be willing to come forward and tell their stories,” said Kitty Westin, Anna’s mother. “When we talk about it openly, it’s not something to be ashamed of.”