NYAPRS Note: New York has mandatory standards for insurance coverage of eating disorders, but it is one of only four states that does. Eating Disorders are anything but a homogenous set of behaviors or a pathological pattern. They impact people across demographics and can appear in unique ways that take just as long to untangle as they do to treat. Brain scans of persons with “disordered” relationships to food or their body demonstrate that chemical reactions mimic that of severe addictions, but the impact on mental health and overall physical well-being, both acutely and longitudinally, are on a whole more severe and devastating than any other psychiatric condition.
Legislation, insurance mandates, and performance indicators for providers around eating disorders may be the most significant yet-to-be-realized avenue for realization of parity.
Missouri Lawmakers Embark on Seventh Attempt to Pass Eating Disorders Bill
Mental Health Weekly; Vol 25, Num 2, 1/12/2015
National and local eating disorder advocates are hopeful that after being introduced in the Missouri legislature seven times, legislation to re- quire health benefit plans to provide coverage for the diagnosis and treatment of eating disorders will finally pass in the 2015 legislative session.
SB 145 would require health benefit plans to provide coverage for the diagnosis and treatment of eating disorders. The bill further requires that the provided coverage include a broad array of specialist services as proscribed as necessary by the patient’s treatment team. Coverage under this legislation is limited to medically necessary treatment, and the treatment plan must include all elements necessary for a health plan to pay claims.
Treatment of eating disorders care would include but not be limited to: medical care, psychological care, psychiatric care, nutritional care, therapy and pharmacy care, according to the legislation. The St. Louis Post-Dispatch reported that 575,000 Missourians — male and female, rich and poor, young and old — are battling eating disorders.
Sen. David Pearce sponsored SB 145. The House version of the legislation, HB 262, sponsored by Rep. Keith Frederick, passed during the last session, but will have to be reintroduced.
“We’re starting all over again,” Annie Seal, chairman of the Missouri Eating Disorders Council, told MHW. Sen. Pearce, said Seal, has refiled the eating disorders bill that this time defines the American Psychiatric Association (APA) Standards of Care guidelines.
“Insurers in the state do not comply with APA Standards of Care guidelines,” said Seal, also a board member of the Missouri Eating Disorders Association. “Hopefully, both the House and the Senate will pass the bill this year,” she said. The bills will have new numbers in the new session, which began Jan. 7.
Seal said the bill has been modified so that it is no longer a mandate. “Insurance mandates are incredibly unpopular in Missouri,” she said. Insurance industry lobbyists “fight tooth and nail against mandates,” Seal said. This is the seventh time the eating disorders legislation has been introduced, she added.
Seal added, “We’re in a unique situation. Technically, eating disorders are supposed to be completely covered. Missouri mental health parity law covers mental illnesses just as it would any medical illness.”
“Insurers believe we want residential [care], but we want access to complete care,” she said.
“The bill is a priority piece of legislation for the senator,” Matt Michelson, spokesperson for Sen. Pearce, told MHW. Why has it taken the introduction of seven bills to get the legislation passed? “We have to get the awareness out there, get champions and get people educated,” Michelson said. The approach is to try to get eating disorders coverage recognized in Missouri under the federal parity law, he said.
Michelson pointed to an actuarial study conducted in the state to determine how much it would cost insurers to cover eating disorders. “It was very nominal,” he said of the study released on Dec. 20, 2013.
According to the “Report for the Joint Committee on Legislative Research — Oversight Division,” the additional costs for plans that currently exclude eating disorders ranged from 0.15 percent to 1.22 percent. For plans that already provide coverage for eating disorders, this increase has a smaller impact and results in a range of 0.04 per- cent to 0.40 percent.
National perspective
“This bill has really evolved,” Lynn Grefe, president and CEO of the National Eating Disorders Association (NEDA), told MHW. “Insurance lobbyists are killing it. Last year there were six ‘no’ votes in the House, and now the goal is for it to pass in the Senate.”
“I wish we had the activism that we have in Missouri elsewhere in the other states,” she said. Insurers need to understand that the illness is unlike other mental health disorders, Grefe said.
“This illness has physical ramifications. If someone had schizophrenia or a bipolar disorder that would be described as a psychiatric illness. What makes this mental disorder unique is that what’s going on in the brain is affecting your physical health,” she said.
Eating disorders need to be treated through a two-pronged approach, noted Grefe. “To take care of the physical treatment, you’ve got to take care of the mental health piece,” she said. The physical part of the illness is so significant, said Grefe, that it can go beyond just your life and relationships. She noted that she has seen someone with rotted teeth from the disorder, desperately in need of dental care. Grefe added, “Eating disorders have the highest death rate of any psychiatric illness. The fight to obtain coverage is so appalling.”
Even though there is no cure, there are effective treatments, she said. “It’s costing a fortune because it is a complicated illness,” Grefe said. Twenty visits to a therapist is considered standard coverage, she said. “Even with that, a person experiencing an eating disorder is not necessarily going to get better,” Grefe noted.
While she can’t quote statistics, Grefe noted that many more people are getting help than ever before. NEDA has received a number of calls from people seeking help, she said. “That’s good news,” Grefe said. “We’ve done a better job of getting people to admit they have an eating disorder. They used to feel [stigmatized].”
Residential care for treatment could cost about $25,000 to $30,000 for about 30 days, she said. “Would a person in need of cancer treatment only receive 30 days?” she said. After 30 days, a person may be taken out of treatment, sent home and still experience a relapse, Grefe added. “The chance of recovery after 30 days is not necessarily likely,” she said.
Insurers, she noted, are frustrated. “They don’t have one bill that’s a fix-it-all or one that guarantees treatment,” she said. NEDA conducted a survey two years ago and found that insurance is the most significant barrier to someone recovering from an eating disorder.
“We need this type of legislation everywhere across the board,” said Grefe, who admittedly is a parent of a child affected by an eating disorder. It’s important to address eating disorders from the onset, she added.
California, Minnesota, New York and New Jersey are among the states that have laws requiring insurers to provide coverage for treatment of eating disorders, she said. Despite the legislative challenges, there is light at the end of the tunnel, Grefe said. “There are appropriate treatments,” she said. “Treatments are getting better. We need insurance companies to stop and re-evaluate [how to address this.] This is a call to arms.” The Missouri Eating Disorders Council’s Seal is also hopeful. “We have a lot of interest from many compassionate legislators who are interested in seeing Missourians get the rights they’re entitled to,” she said. “I hope the seventh time is the charm.”
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