California Insurance Lawyer Blog

Kantor & Kantor is pleased to announce that Governor Jerry Brown has signed into law S.B. 621. California State Senator Ron Calderon first proposed the legislation, which regulates life and disability insurance policies, and bans discretionary clauses in such. Previously, insurers included such clauses in group insurance policies and certificate, granting themselves the power to interpret terms of the policies, and to make eligibility determinations based on their own interpretations. This law provides that if a policy, contract, certificate, or agreement offered, issued, delivered, or renewed, whether or not in California, that provides or funds life or disability insurance coverage for any California resident contains a provision that reserves discretionary authority to the insurer, or an agent of the insurer, to determine eligibility for benefits or coverage, to interpret the terms of the policy, contract, certificate, or agreement, or to provide standards of interpretation or review that are inconsistent with the laws of California, that provision would be void and unenforceable.

The law authorizes the Insurance Commissioner to adopt regulations reasonably necessary to implement these provisions.

This law will change how federal Judges consider insurance cases going forward. Previously, in the event a disabled person filed a lawsuit against an insurance company that had included a discretionary clause in its policy, the federal Judge reviewing the case would be required to defer to the insurer’s decision, rather than look at the evidence for and against disability, and weigh it accordingly. In essence, the Judge would have to assume the insurer was correct in denying a claim, unless the plaintiff could prove that the insurer’s decision was arbitrary, unreasonable, capricious or clearly wrong. The scales were tilted, in favor of the insurers, who had self-granted discretion. Now, the scales will be level again.

ERISA (which stands for the Employee Retirement and Income Security Act) was a federal law passed in 1974 which governs, among other things, employee benefits. This law governs cases brought by, for example, disabled employees who are seeking their employer-provided disability insurance benefits, which have been denied. Because these employer-provided benefits fall under the governance of the federal ERISA law, any lawsuits for such benefits must be filed in federal court. The ERISA statute only applies to life and disability insurance policies, NOT health insurance policies. Hopefully, the law will soon be expanded to encompass health coverage.

Glenn Kantor was instrumental in assisting in the passage of this bill. He provided expert testimony in California state legislative hearings in Sacramento, and continues to fight for his clients whose policies may or may not contain such discretionary provisions.

For more details you can visit Senator Calderon's site: http://dist30.casen.govoffice.com

The International Association of Eating Disorder Professionals will stream an encore of Kantor & Kantor partner Lisa Kantor’s 2011 symposium presentation How to Document Evidence Based Treatment to Maximize Insurance Reimbursement, followed by a live teleconference call with Ms. Kantor Tuesday, Sept 27, 200, at 7 pm ET/6 pm CT/5 pm MT/4 pm PT. The presentation reviews insurance carrier criteria for treatment of eating disorders and explains how evidence-based treatment records can be documented to best maximize the client's available insurance benefits.

“A provider's treatment records are the foundation for establishing medically necessity for admission and continued treatment,” says Ms. Kantor, who has been recognized as one of the top lawyers in the country representing policyholders denied benefits for treatment of eating disorders. “Evidence-based treatment records must show plans of care, symptoms, and objective evidence that satisfy an insurance company's criteria for admission and continued care.”

Although only IAEDP members may participate in the live session, nonmembers and others unable to attend may submit questions about insurance benefits for eating disorder treatment to Rachel Teicher at rteicher@kantorlaw.net before, during and after the live session.

IAEDP members may register for the call by following this link: http://myaccount.maestroconference.com/conference/register/XVQ38AL38L6GVOVQ.

The 90-minute presentation is available for preview through this link: http://player.netromedia.com/?ID=5a57395a-560a-4073-9562-13acf1b7f32c&path=/IAEDPKantor%20in%20wmv.wmv.

Additional materials may be downloaded here: http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders/2011_IAEDP_Materials.aspx.

Thanks to the excellent efforts of attorneys Lisa Kantor and Elizabeth Green of Kantor & Kantor, LLP, the Ninth Circuit Court of Appeal issued an important decision on August 26, 2011 favoring policyholders in California. The question before the court was whether or not Blue Shield was required to pay for plaintiff's care at a residential treatment facility. The court held that although, technically, the terms of Jeanene Harlick's health insurance policy with Blue Shield did not require coverage, the California Mental Health Parity Act absolutely did require Blue Shield to pay for treatment. Ms. Harlick has suffered from anorexia nervosa for more than 20 years. In 2006 and 2007 she spent time at a residential treatment facility in an effort to help her cope with her eating disorder. Blue Shield refused to pay the substantial cost for that treatment.

The Ninth Circuit Court of Appeal’s opinion in Harlick is a major victory for all of those who are insured by Blue Shield of California and who suffer from eating disorders A stay in a residential facility that provides 24-hour supervision can be a crucial part of the successful treatment of an eating disorder. Almost all insurance companies that provide behavioral health benefits provide coverage for residential treatment. Blue Shield is one of the few insurers who exclude such treatment, while providing coverage for all other levels of care. The California Mental Health Parity Act requires insurance companies to provide coverage for the treatment of “severe mental illnesses,” including anorexia and bulimia, on the same terms and conditions as it does for physical illnesses. In its decision today, the Court held that the Mental Health Parity Act requires an insurer to provide all medically necessary treatment for eating disorders, including residential treatment, even if the insurance plan has an exclusion for that treatment.

The full text of the decision can be read by clicking here:

HARLICK v. BLUE SHIELD OF CALIFORNIA

The National Eating Disorders Association (NEDA) commends General Mills for pulling a controversial television commercial for Yoplait yogurt off the air after NEDA voiced concerns that the commercial may encourage disordered eating behaviors.

The commercial shows a thin woman agonizing over the decision of whether or not to eat a piece of raspberry cheesecake. Her internal dialogue shows her rationalizing the choice to eat a slice if she only ate celery sticks for dinner or if she jogged in place while eating it. This is typical of the type of bargaining and rationalizing about food choices conducted by sufferers of eating disorders every time they are confronted with a choice about food. When Lynn Grefe, president and CEO of NEDA and her colleagues first saw the commercial, what they saw wasn’t a woman making a healthy food choice, but one who was caught up in a compensatory exchange about food, Grefe said. “This felt like a 20 second look at the mind of somebody with an eating disorder.”

General Mills responded to the concerns by immediately taking the commercial off the air. Tom Forsythe, vice president of corporate communications for General Mills said, “[A]ny correlation was certainly unintentional. But if even a few people could take from the ad that mis-impression, then the right thing to do was to pull the ad—and we have.” In a public statement, Grefe thanked Yoplait and General Mills for addressing their concerns so quickly and stated, “I believe the company had no intent to harm and gained insight into a very serious issue that we hope will influence their marketing decisions in the future.”

To view the entire commercial and further commentary, go to:
http://shine.yahoo.com/channel/health/does-this-commercial-encourage-eating-disorders-video-2497971/
National Eating Disorder Association (NEDA) website: www.nationaleatingdisorders.org

After years of uncertainty, an important legal question was finally resolved by the United States Court of Appeals for the Ninth Circuit in an opinion, Cyr v. Reliance Standard Life, issued today, June 22, 2011.

Sitting en banc, the Court considered whether or not an insurance company, acting as the administrator for an ERISA group disability plan, could be sued in its own name as a defendant in a lawsuit for benefits. For years, insurance companies have been arguing that they are not proper party defendants. The companies have successfully been forcing plan beneficiaries to try and track down plan administrators -- who are sometimes difficult to find, or expensive to serve -- in order to timely and properly file a lawsuit. Suing a plan administrator of an insured plan is nothing more than a charade, as it is the insurance companies who usually have final say about whether benefits will be paid. Because of a loophole in the law, insurers were able to frustrate plan participants who wanted to sue for benefits but who were not able to identify and/or properly serve the plan administrator. That game is now over.

Writing for the Court, Chief Judge Alex Kozinski said "[w]e conclude, therefore, that potential liability under 29 U.S.C. § 1132(a)(1)(B) is not limited to a benefits plan or the plan administrator." The Court went further and overruled previous authority which has been used for years by insurance companies to thwart plaintiffs: "Any statements or suggestions to the contrary in our prior decisions, including Ford v. MCI Communications Corp. Health & Welfare Plan, 399 F.3d 1076, 1081 (9th Cir. 2005); Everhart v. Allmerica Financial Life Insurance Co., 275 F.3d 751, 756 (9th Cir. 2001); Spain v. Aetna Life Insurance Co., 13 F.3d 310, 312 (9th Cir. 1993); and Gelardi v. Pertec Computer Corp., 761 F.2d 1323 (9th Cir. 1985), are overruled."

The Court's full decision can be read by clicking this link: http://www.ca9.uscourts.gov/datastore/opinions/2011/06/22/07-56869.pdf

On May 11, Lisa Kantor argued before the 9th U.S. Circuit Court of Appeals in San Francisco, on behalf of client Jeanene Harlick, who has suffered from anorexia for more than 20 years. Ms. Harlick entered a residential treatment facility on the advice of her doctor. After initially approving coverage for the treatment, Ms. Harlick’s insurer Blue Shield denied coverage after only 10 days, even though the insurer agreed that such treatment was medically necessary.
Ms. Kantor contends that Blue Shield abused its discretion in denying coverage and that its actions violate California’s Mental Health Parity Act, which mandates that health plans provide the same coverage for severe mental illness as they provide for physical disease. In Harlick’s case, Blue Shield covers sub-acute treatment for physical conditions at skilled nursing facilities. At the same time, Blue Shield denies responsibility for the cost of sub-acute treatment for severe mental illness at residential treatment facilities.

“For the act to have any real meaning,” argues Ms. Kantor, “Blue Shield must provide the same levels of health services for severe mental illness as it does for physical illness. Otherwise the purpose and plain language of the statute is violated, and the discrimination against those with severe mental illness, which the statute was designed to correct, will be allowed to continue.”
Ms. Kantor is among only a few lawyers in the country who include as part of their practices representation of people with eating disorders who have been denied benefits for residential treatment. The fight has occupied two fronts: while regularly scoffing at both state and federal mental health laws to deny coverage, some insurers – including Blue Shield – rewrote policies effective Jan. 1, 2011, to specifically deny benefits for the 24-hour supervised care many people with eating disorders require for recovery. Instead, these insurers only pay for 9-hour day treatment outside of residential facilities. This new policy has already begun to erode the gains made by many people who have fought to have residential treatment care paid for by their insurance companies.

The International Association of Eating Disorder Professionals filed an amicus brief in support of Ms. Harlick and the contention that California Mental Health Parity Law applies to her case, Harlick v. Blue Shield of California, 10-15595. You can listen to the oral argument before the court by clicking here: http://www.ca9.uscourts.gov/media/view_subpage.php?pk_id=0000007519

For more information about Lisa Kantor and legal assistance for eating disorders, follow this link: http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx.

From 2009, to 2010, United Healthcare cut in half the compensation of its Chief Operating Officer, Stephen J. Hemsley. At first blush, it would appear United Healthcare is recognizing the ballooning costs to consumers of healthcare, and it acting responsibly. First looks can be deceiving. See http://blogs.courant.com/connecticut_insurance/2011/04/unitedhealth-ceos-pay-dropped.html

In 2009, Hemsley received $102 million in total compensation from United Healthcare. In 2010, his pay was cut in half, but even after a 50% reduction, he still received an exorbitant $48.8 million dollars in compensation. The majority of this pay was in the form of stocks and stock options ($ 44 million), in addition to the $4.8 million in he was paid in salary, incentive pay, and other compensation. Putting his compensation into perspective, his 2010 compensation is equal to the sum total of the average annual household income of 2,000 American households. It would also be enough to pay a $500 monthly health insurance premium for 8,500 families. See http://www.moneytalksnews.com/2010/04/17/insurance-outrage-hike-prices-pay-ceo-100000000/

How can United Healthcare justify its continued premium increases, based on rising healthcare costs, while at the same time paying its Chief Executive $48,800,000? Shouldn’t the Board of Directors of United Healthcare be more concerned with its policyholders’ ability to access and receive quality care rather than compensating its officers in such an outrageous manner?
Andrew Goldstein of corporate compensation adviser Towers Watson says, “We all kind of scratch our heads when executives are making millions, and (corporate) directors feel obligated to give them $10,000 for financial planning, It’s not like directors haven’t thought about getting rid of perks. They’re still a sticking point for a lot of executives. They feel it’s part of their compensation package. And it’s a stature thing.” So it seems that despite these tremendous salaries, CEO’s continue to cling to these perks at the health expense and financial burden of those less fortunate. Simply because directors feel obligated, and executives feel entitled. See http://www.usatoday.com/money/companies/management/2011-04-11-CEO-perks.htm

While families struggle to afford the soaring increases in insurance rates and battle the stresses of paying for prescriptions, doctor visits, and various health issues, United Healthcare remains “America’s largest commercial health insurer based upon revenue”, seemingly profiting from our medical woes. If it wasn’t so sad, and if so many Americans were not suffering from the consequences of being uninsured, classifying compensation of $49 million dollars as “pay cut,” would be comical. Perhaps the various departments of insurance, and our legislature, should look a lot more closely at insurance executive compensation when considering how to regulate insurance costs and fix our insurance crises.

On April 12, 2011, Kantor & Kantor partner, Lisa Kantor was one of five speakers in a Congressional Briefing in Washington D.C., entitled “Addressing Eating Disorders Through the Federal Response to Eliminate Eating Disorders Act.” This Briefing was sponsored by The Eating Disorders Coalition in cooperation with Senator Tom Harkin (D-IA).

The "FREED" Act is the first comprehensive eating disorders bill in the history of Congress that provides needed action for research, treatment, education and prevention of eating disorders. The Act recognizes that eating disorders are serious and life threatening, but that with adequate and appropriate treatment people do and can recover. That Act also requires research, education and prevention so that we can better understand, treat, prevent, diagnosis and intervene early with eating disorders patients.

Click here to read Ms. Kantor’s speech.

We recently obtained a Judgment against Anthem Blue Cross regarding its refusal to pay for 2 weeks of inpatient treatment for our client who struggled with an eating disorder. The client, a middle-aged woman, sought treatment for her anorexia nervosa at Pacific Shores Hospital, in Oxnard, California. Her health insurer, Anthem Blue Cross, agreed to pay for the first part of the doctor prescribed treatment, but then cut off benefits before the treatment program was complete. Anthem informed her of its denial on March 19, with a retroactive denial date of March 11. Since her doctors advised her to complete the program they had set for her, our client paid out of pocket for her last 2 weeks of treatment.

Our client successfully completed her stay at Pacific Shores Hospital and went home, equipped with strategies learned during her five-week-long treatment, to maintain a healthy body weight and image. She continues to be conscientious in her recovery and has returned to her active life and hobbies, including horse-back riding. Her case is an example of how focused treatment for eating disorders, uninterrupted by insurance claims denials, can be highly effective.

On April 12, Lisa Kantor will join other eating disorder activists in Washington, D.C. to lobby Congress to pass the FREED Act, H.R. 1193, the Federal Response to End Eating Disorders, a comprehensive bill that addresses eating disorder research, treatment, education and prevention. Ms. Kantor, a partner in Kantor & Kantor, will be part of a select group of panelists who will speak to a congressional committee about how U.S. institutions could change attitudes and perceptions to encourage and promote effective treatment of and recovery from eating disorders.

Most notable, Ms. Kantor will testify about insurance and health plan attempts to both construe and limit policy language in ways that deny coverage for treatment in specialized residential facilities. For example, in January some insurers completely eliminated residential treatment as a covered mental health benefit, despite clinical evidence demonstrating that residential treatment is a critical stage of comprehensive and effective treatment for many individuals suffering from eating disorders.

“This is an alarming trend that not only narrows treatment options for people suffering from eating disorders but also could put many facilities out of business,” says Ms. Kantor. “If these health insurers are successful in their attempts to undermine effective treatment for eating disorders, other health plans will follow their dubious leadership. That will life-threatening to many people seeking full recovery.”

Ms. Kantor is among only a few lawyers in the country advocating for insurer reimbursement for clients with eating disorders. She has a number of significant wins for these clients, including cases that have changed the law in California and the 9th Circuit. She is currently working with eating disorder professionals and facilities to determine what actions to take to change the insurance industry’s perception about care for eating disorders and what regulatory, legislative and class action litigation measures are necessary. Ms. Kantor has been a keynote speaker for the International Association of Eating Disorder Professionals and frequently speaks to other groups about health insurance issues and eating disorders. For more information, call (800) 446-7529 or contact Ms. Kantor at lkantor@kantorlaw.net.

For more information about the FREED Act, go to http://www.eatingdisorderscoalition.org/documents/summaryofFREEDAct.pdf.

One of our clients is a 21 year-old woman, who has struggled with anorexia nervosa since she was 12 years old. In 2009, her condition had deteriorated to the point that she entered a residential treatment center. Her insurance, which is administered by United Behavioral Health (UBH), initially authorized her treatment, but after only two and a half weeks, UBH denied further treatment on the grounds that she could be treated in a day treatment program. Our client left residential treatment and enrolled in such a program, but, after only 10 days, UBH denied further treatment.
Throughout 2010, our client’s condition further deteriorated, until she was only 74 percent of her ideal body weight. Knowing that she needed residential treatment and fearing that UBH would again deny such treatment, our client raised enough money from internet fund raising and from her parents to pay for eight weeks of residential treatment.

Our client again entered a residential treatment center in November 2010. As in 2009, UBH initially approved her treatment, but then denied further treatment after only a few weeks. This time, however, our client she retained our firm and we filed a request for an independent medical review with the California Department of Managed Health Care (DMHC), supported by declarations from her doctor and therapist explaining why she needed residential treatment. While the request was pending, our client paid for continued treatment with the money she had raised.

The independent medical reviewer agreed and, on February 22, 2011, the DMHC ordered UBH to pay for our client’s treatment. The independent medical review found that residential treatment was medically necessary from the date of UBH’s denial in December 2010 and that UBH had to pay “for additional services while the patient prepares to transition to a lower level of care.” The DMHC gave UBH five working days to implement its decision. Incredibly, at the end of the five working days, UBH again denied our client further treatment.

Luckily, after the DMHC’s decision, we had filed a lawsuit against UBH for the emotional distress its conduct had caused our client. The day after the lawsuit was served on UBH, it reversed its decision and authorized further residential treatment. However, after only 10 more days, UBH again denied further treatment.

California law requires that UBH reimburse our client for the money she had paid for her treatment within five working days of the DMHC decision overturning UBH’s initial denial or face a $5,000 a day fine. Incredibly, though it is now over 30 days after the DMHC’s decision, UBH has still not paid.

We will vigorously pursue the lawsuit on behalf of our client to recover the monies she is owed and compensation for the emotional distress and other damages caused by UBH’s outrageous conduct.

Wall Street Journal writer Avery Johnson reported recently that defining “essential benefits” is the latest insurer roadblock in implementing the federal health reform legislation. See “Defining Essential Care.”

The debate revolves around the difference between rehabilitative services, relearning skills lost through disease or injury, versus “habilitative” services, the process of acquiring new skills. Insurers tend to label habilitative skills educational or experimental, thus falling outside of coverage.

Health law divides essential services into 10 categories, each containing treatments that could fall within either rehabilitative or habilitative services, depending on how the debate is decided. Insurers want to keep the habilitative services categories as broad as possible so they have flexibility in designing benefits packages, writes Johnson.

Medical professionals believe if coverage specifics for these treatments are not spelled out in detail, insurers have more leeway to delay and deny benefits. Allowing insurers to determine habilitative services is problematic as well, particularly since the determination will likely fall along financial, rather than medical, lines.

Under the mental health and substance-abuse disorders category, the debate concerns the length of stay in a treatment facility. Other treatments under question include unlimited physical therapy and nutrition counseling.

Arguing about how long a patient may stay in a residential facility is nothing new. Health plans must be salivating over the option to have the power to draw a bright line to determine an appropriate length of stay in a treatment facility or to decide when rehabilitation turns into habilitation. But since each individual is different, those diagnoses must remain in the hands of skilled medical professionals.

Especially troubling to us is the impact this debate could have on treatment for eating disorders. In many states, eating disorder treatment is covered as a mental health condition. To save money, employers are beginning to drop mental health coverage as part of their health plans. Some plans have implemented new rules this year that deny coverage benefits for residential treatment of eating disorders. Even something as simple of denying benefits for nutrition counseling could be a life-or-death decision for some patients.

Rulemakers must also realize that decisions made in the context of plans sold on insurance exchanges could also inform how insurers will interpret employer-provided plans. The erosion of coverage for mental health issues is alarming. Regulators need to ensure this trend doesn’t weaken the protection the federal government plans to endorse.

We continue to see evidence in insurance company claim files that insurers are not only conducting traditional surveillance, following their insureds/our clients around, but the insurers are using the internet to snoop around and learn as much as they can about claimants, their activities, their family members, etc.

We know the insurance companies do this to protect against fraud, and there is nothing wrong with that. But, all too often, the insurers get a bit overzealous, and even intrusive in their conduct, and they start to treat everyone like a criminal of some sort.

Perhaps the most shocking example of this activity we’re aware of, is a case of one major insurer accessing private files off of a claimant’s computer. It appears that the insurer may have actually hacked into its insured’s private computer to obtain information related to internet activities, e-bay purchases, YouTube viewing history and private files.

Such activity is, of course, illegal, and may give rise to, among other things, an invasion of privacy cause of action. We continue to remind our clients and anyone with insurance who may or may not ever make an insurance claim: do not take internet privacy for granted. While it is one thing for an insurance company or any other entity or individual to illegally access your private information, it IS legal for anyone to track your internet activities you put in the public sphere of cyberspace. Be mindful that what you post, blog about, advertise, or share on social networking sites, message boards, in online fora, etc. is fair game. Moreover, the reality is often that the picture one portrays of him or her self in cyberspace, may not be a complete picture of that person's life. Unfortunately, when it comes to insurance claims, and particularly ERISA claims, such a picture may be the only one a court sees. Be mindful.

Attorney Lisa Kantor presents her seminar topic “How to Document Evidence-Based Treatment to Maximize Benefits,” to the International Association of Eating Disorder Professionals (IAEDP) Friday, March 4, 2011, from 2:00 p.m. to 3:30 p.m., at the group’s annual conference in Phoenix, AZ. Ms. Kantor’s session will review the criteria from insurance companies for treatment of eating disorders and explain how evidence-based treatment records can be documented so as to comply with insurance company guidelines for reimbursement as much as possible.

“When seeking insurance benefits for eating disorder treatment, a provider’s records will be the foundation for establishing medically necessity for admission and continued treatment,” explains Ms. Kantor, a partner in the Los Angeles area law firm Kantor & Kantor, LLP. “Evidence-based treatment records must show plans of care, symptoms, and objective evidence that satisfy an insurance company’s criteria for admission and continued care.”

The primary reasons insurers deny treatment is “lack of medical necessity.” Insurance companies determine medical necessity by applying their criteria to the request for benefits. While criteria such as symptoms, plans of care and facility qualifications vary among the different health insurers, successful claims decisions almost always require thorough documentation from every member of the treatment team. Ms. Kantor’s presentation will instruct conference attendees how to create a document file that should meet insurer demands as well as create a record for appeal and litigation.

Ms. Kantor is among only a few lawyers in the country advocating for insurer reimbursement for clients with eating disorders. She has a number of significant wins, including eating disorder cases that have changed the law in California and the 9th Circuit. She is currently working with eating disorder professionals and facilities to determine what actions will change the insurance industry’s perception about care for eating disorders and what regulatory, legislative and class action litigation measures are necessary. Ms. Kantor has been a featured speaking for the Los Angeles, Orange County and San Diego chapters of the IAEDP.

For more information about obtaining insurance benefits for eating disorder treatment, log on to www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.aspx or call (800) 446-7529.

While people around the country were celebrating the passage of the Mental Health Parity and Addiction Equity Act in 2008, some health plans were quietly planning to drop mental health and addiction coverage before the act became effective in 2011. Groups such as the Screen Actors Guild and the Plumbers Welfare Fund, as well as United Security Life and Health Insurance Co., will no longer provide such benefits to their insureds in an effort to control costs, reports the Wall Street Journal. See “Law Prompts Some Health Plans to Cut Mental Health Benefits,” http://online.wsj.com/article/SB10001424052748703395904576025410628499574.html.

Mental Health Parity legislation requires that plans offering mental health coverage do so under the same terms and conditions as coverage for physical ailments. To circumvent the law, some health plans have dropped the coverage or changed the benefits they offer their members. What this means for SAG members, for example, is that something as simple as a prescription for an antidepressant won’t be covered by insurance. And this itself is depressing news for the entertainment industry, which according to the federal Substance Abuse and Mental Health Services Administration and reported in the WSJ, ranks in the top three business segments in rates of illicit drug and heavy alcohol use.

The outlook, however, may not be so dismal for other industries. According to blogger David E. Williams, the WSJ may not have looked deeply enough into the Kaiser Family Foundation report that prompted the article. “Of firms surveyed by Kaiser Family Foundation, 69 percent were not changing their mental health and substance abuse benefits at all. Of the 31 percent that were changing such benefits, 66 percent were eliminating limits on coverage. Only 5 percent of the 31 percent (or about 1.5 percent of the total) were dropping their mental health coverage,” writes Williams. See “Wall Street Journal Lost Its Way on Mental Health Policy,” http://www.medcitynews.com/2010/12/wall-street-journal-lost-its-way-on-mental-health-policy/.

Although it’s likely too soon to know for sure how most health plans will ultimately respond to mental health parity laws, from our experience most will do whatever they can get away with to increase their profits. And that would be unfortunate.

Both the federal and state mental health parity laws have been lifesaving measures for more than people with substance abuse problems. They have allowed thousands of women with eating disorders to obtain the level of care they need for effective treatment and cure, something that was largely unavailable before such laws were enacted. Thousands more could be denied necessary residential treatment should more health plans choose to drop mental health coverage.
Williams notes that the Congressional Budget Office projected mental health parity would raise premiums a mere 0.4 percent, and pointed to actuarial evidence that that spending on mental health and substance abuse benefits lowers overall healthcare costs.

Those are statistics we urge the health insurance industry to ponder, rather than reacting to fears that mental health costs will impact their coffers.

If you have been denied health benefits for an eating disorder, addiction or other mental health issue, call us at (800) 446-7529. We can help.

The third annual Jackie Bristow Memorial 5k Run/Walk on January 8, 2011 was a reminder that the effects of eating disorders can be deadly. The race memorializes Jackie Bristow who died at the age of 19 from heart failure, brought on by an electrolyte imbalance caused by her eating disorder. The evidence of eating disorders is not always apparent, as Jackie’s mother explained: “This is killing girls that aren't sensationally thin,” Joan Bristow said. “It's very secretive and it can go unnoticed for a long time.”

By the time our clients seek treatment, they have lived with their eating disorders for months, or even years. Awareness is crucial to prevention and early intervention. As we approach Eating Disorder Awareness week in February, find a race in your area and support awareness and prevention of eating disorders:

http://www.sgvtribune.com/rss/ci_17028981?source=rss

Merrick’s Walk in Atlanta, GA on March 27, 2011
http://www.active.com/running/atlanta-ga/merricks-walk-and-5k-fun-run-2011

Third Annual Freedom Run in Lancaster, PA on October 8, 2011
http://www.goracego.com/search/event.aspx?event=28eb7704-4a91-4e22-ad59-4ddba02140ae.aspx

Bust a Move 5k Run/Walk in Troy, NY on April 9, 2011
http://www.active.com/running/troy-ny/bust-a-move-5k-runwalk-2011

National Association of Eating Disorder Walks http://www.nationaleatingdisorders.org/programs-events/nedawareness-week-walk.php

Tampa Bay, FL
February 19, 2011

Orlando, FL
February 20, 2011

Oklahoma City, OK
February 26, 2011

Raleigh, NC
April 3, 2011

Napa, CA
June 11, 2011

Long Beach, CA
July 23, 2011

Anorexia risk may be genetic, reports a new study in Molecular Psychology. The study was the largest ever conducted to look for genetic markers for anorexia and found both variations in gene sequences and in segments of DNA either duplicated or deleted. Study researcher Dr. Hakon Hakonarson, director of the Center for Applied Genomics at The Children’s Hospital of Philadelphia, and his colleagues scanned the genomes of 1,003 people with anorexia (whose average age was 27), and compared them with the genomes of 3,733 children (whose average age was 13) who did not have anorexia. The researchers found a few spots along the genome where the two groups differed and determined these “single-nucleotide polymorphisms (SNPs) could play a role in the genetic underpinnings of anorexia. See “Anorexia Risk May Be Determined by Genetics,” http://www.msnbc.msn.com/id/40325171/ns/health-mental_health/.

A recently published study in the American Academy of Pediatrics Journal reports an alarming trend of children as young as 10 turning to internet chat rooms to learn weight loss or purging methods that can exacerbate anorexia and bulimia. Rebecka Peebles, who authored the study, is urging parents to gain greater awareness about how such unmonitored, interactive sites could affect the health of their teens and pre-teens. The report also addresses how the medical profession’s emphasis on treating obesity in children and adolescents may have placed an unhealthy emphasis on weight loss and dieting. The report documents an increase in cases of anorexia and bulimia among pre-teens, males and minorities during the past decade. Although a full report is not available online, the AAP has posted a policy statement about Identifying and Treating Eating Disorders at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/1/204.

Kantor & Kantor, LLP can help get your insurance claims for eating disorder treatment expenses paid.

Anorexia risk may be genetic, reports a new study in Molecular Psychology. The study was the largest ever conducted to look for genetic markers for anorexia and found both variations in gene sequences and in segments of DNA either duplicated or deleted. Study researcher Dr. Hakon Hakonarson, director of the Center for Applied Genomics at The Children’s Hospital of Philadelphia, and his colleagues scanned the genomes of 1,003 people with anorexia (whose average age was 27), and compared them with the genomes of 3,733 children (whose average age was 13) who did not have anorexia. The researchers found a few spots along the genome where the two groups differed and determined these “single-nucleotide polymorphisms (SNPs) could play a role in the genetic underpinnings of anorexia. See “Anorexia Risk May Be Determined by Genetics,” http://www.msnbc.msn.com/id/40325171/ns/health-mental_health/.

A recently published study in the American Academy of Pediatrics Journal reports an alarming trend of children as young as 10 turning to internet chat rooms to learn weight loss or purging methods that can exacerbate anorexia and bulimia. Rebecka Peebles, who authored the study, is urging parents to gain greater awareness about how such unmonitored, interactive sites could affect the health of their teens and pre-teens. The report also addresses how the medical profession’s emphasis on treating obesity in children and adolescents may have placed an unhealthy emphasis on weight loss and dieting. The report documents an increase in cases of anorexia and bulimia among pre-teens, males and minorities during the past decade. Although a full report is not available online, the AAP has posted a policy statement about Identifying and Treating Eating Disorders at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;111/1/204.

Anyone touched by or concerned with eating disorder issues should also be aware of the valuable resources provided by the International Association of Eating Disorders Professionals Foundation (IAEDP). Check out their website: http://www.iaedp.com/