Jacobs v. Kaiser Foundation Health Plan, Inc. – Court Orders Kaiser to Pay for Eating Disorder (Bulimia)Treatment

In January 2008, Lisa Kantor won an appellate decision for a client suffering from an bulimia. In Jacobs v. Kaiser Foundation Health Plan, Inc., 04-57131 (C.D. Cal. Jan. 30, 2008), Laura Jacobs, was diagnosed with life-threatening bulimia, but was denied adequate treatment by her medical plan provider Kaiser. Kaiser did not offer adequate treatment for plan participants, and declined to refer Ms. Jacobs to an out-of-plan treatment facility. It further refused to pay for the cost of treatment when Ms. Jacobs’ mother obtained the care her daughter desperately needed by checking her into an eating-disorder treatment facility. Although the lower court found that Kaiser had not abused its discretion in denying treatment, the Court of Appeal ruled that her mother’s “decision to take Laura outside the Kaiser treatment system may have saved her daughter’s life.” The case was reversed and remanded with instructions for the lower court to reimburse the Jacobs’ for the non-plan services and to pay Ms. Kantor’s fees and costs.

Although the Jacobs case was unpublished, it is still part of only a few appellate decisions addressing the issue of health coverage for eating disorders. In January 2006, Lisa Kantor previously won the first published appellate decision in an eating disorder case where her client was denied benefits for in-patient treatment of bulimia. In Thompkins v. BC Life and Health Ins. Co., 414 F.Supp2d 953, (C.D.Cal. 2006), the Court of Appeal interpreted California’s mental health parity law AB88 to include beneficiaries who did not live or seek medical care in California. That law requires health insurance policies to cover treatment for mental illness (including eating disorders) on the same terms and conditions applied to other medical conditions. As such, BC Life and Health was obligated to pay Ms. Kantor’s client benefits under its plan.

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