The largest health insurance provider in New Jersey has agreed to settle a class action lawsuit brought by families who claimed they were denied adequate coverage for eating disorders.
Under the tentative agreement, which still must be approved by the federal judge overseeing the case, Horizon Blue Cross Blue Shield of New Jersey will now treat eating disorders as biologically based illnesses, which will entitle patients to greater coverage. The settlement covers only the beneficiaries of fully insured plans.
The lack of full coverage has been one of the main complaints of families of people who suffer from eating disorders, many of whom have had to pay tens of thousands of dollars out of pocket for treatment.
Advocates and doctors said they hope the settlement, one of the first of its kind, will lead other insurance companies to take similar steps.
"We hope this really influences the way we view and how seriously we take the issue of eating disorders," said Dr. Ovidio Bermudez, medical director of the Eating Disorders Program at Laureate Psychiatric Clinic and Hospital in Tulsa, Okla. "My hope is this will set the stage for other third party payers to take a look at the seriousness of eating disorders."
Horizon Blue Cross of New Jersey agreed to pay about $1.2 million to 500 patients. In court papers, the plaintiffs' lawyer said that the expanded coverage for eating disorders would apply to more than 1 million people and would likely pay out $20 million over the next 15 years.
Horizon BCBSNJ spokesman Tom Rubino said in a statement: "Horizon Blue Cross Blue Shield of New Jersey believes the settlement is in the best interest of all the parties involved and in line with the direction of federal parity law for mental health."
An estimated 11 million people in the United States have eating disorders, the vast majority of them young females, but many insurance companies have been reluctant to cover the full extended cost of treatment, which can run more than $1,000 a day.
In many states, insurance companies cover 30 or 60 days of hospital care a year. Only 13 states mandate coverage for at least some eating disorders, said Diane Robertson at the ECRI Institute, an independent nonprofit organization that tracks such legislation.
Those policies, advocates say, have left families with massive debt.
"I see families go broke over this," said Lynn Grefe, CEO of the National Eating Disorder Association. "It's real discrimination as far as I'm concerned."
Dawn Beye, one of the families who sued Blue Cross Blue Shield in New Jersey, said in an interview earlier this year that her daughter's struggle with anorexia cost her family more than $300,000 after their insurer refused to cover more than 30 days of hospital treatment a year.
Over the last three years, Beye's daughter, who is now 18, has spent a total of more than a year in the hospital. The disorder has caused the girl serious medical problems, including a reduced heart rate and bone thinning, Beye said.
"Financially, we were devastated," she said. "We lost everything that we worked for, for a college education. We had to tap into every resource that was available."
Beye's attorney said Horizon Blue Cross Blue Shield of New Jersey agreed to reimburse a "significant" amount of her out-of-pocket costs after she filed a class-action in New Jersey.
"It's so difficult to see someone that you love struggle with this, and then have to fight with the insurance company to get them well," Beye said. "We're going to lose more and more people" to eating disorders.