Families Battle Insurers Over Eating Disorders

Families fight insurers over coverage for eating disorders.

ByABC News

June 10, 2008— -- Janell Smith struggled with an eating disorder for months. By the time she was hospitalized, in January 2003, the 26-year-old weighed 68 pounds and needed to be put on a feeding tube to save her life.

Less than a month later, according to a lawsuit filed by her parents, Brian Smith got call from his daughter's insurer saying she would be discharged in four days. Within days of her release, she committed suicide.

The lawsuit, which is scheduled to go to trial this month, alleges that their insurer decided to discharge Smith over her father's protests and without consulting with her doctors, who, despite her gradual weight gain, believed she was not healthy enough to be released.

The Smiths' case is one of several court fights around the country between insurance companies and families of those who suffer from eating disorders, who have lost loved ones or spent tens of thousands of dollars on treatment that, they claim, should have been covered by insurance.

Brian Smith found his daughter's body inside her apartment a week after she left the hosptial. She had overdosed on Tylenol, vodka, cocaine and other drugs. Smith said he found empty food wrappers around her. She died three days later.

"For them to say she's being discharged — I was saying what do you mean? How can you do this?," he said. "With the proper length of stay and care she would still be here today. I think about her all the time. It's been five years, and it's still a huge loss."

According to the lawsuit, Janell Smith's counselor told her parents that their insurance company was "pulling the plug" on Janell's hospitalization. Her treating psychiatrist wrote in a discharge summary that releasing her from the hospital would increase her risk of relapse, according to court records.

Their insurance company, Magellan, has argued that it never discharged Smith, but merely authorized another four days of hospitalization with the intention of reviewing her case again. It said Janell Smith discharged herself, that her doctors did not request extended hospitalization and there was no indication she was suicidal.

"This case has been portrayed as a denial of benefits, and that is simply not the case," said Erin Somers, a Magellan spokeswoman. "All the care that was requested by her providers was authorized by us. Additional care could have been authorized if it had been requested, but it wasn't."

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.

Though the Smiths' insurance policy covers the full cost of treatment for Janell's anorexia, in many states, insurance companies do not, instead only covering 30 or 60 days of hospital care. 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 said 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.

Beye's daughter, now 18, spent more than a year of the last three in the hospital. The disorder has caused her daughter serious medical problems, she said, including a reduced heart rate and bone thinning.

"Financially, we were devastated," Beye 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 the insurer, 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.

The suit claims insurance companies in New Jersey should treat eating disorders as biologically based illnesses, like schizophrenia, which would have entitled their daughter to greater coverage. Neither Beye nor her lawyer would disclose how much the company paid. Blue Cross said medical privacy laws prohibited it from commenting on the specifics of Beye's case.

"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.

Horizon Blue Cross Blue Shield of New Jersey has argued that there is no proof that eating disorders are caused by biological, rather than psychological and environmental factors.

In a statement, the company said it provided the Beye family "with all of the contracted benefits they are entitled to under their policies," adding, "historically, and in light of presently existing evidence-based medical research, eating disorders are not biologically based mental illnesses."

"Most people understand that health insurance companies cannot pay 100 percent of each and every desired medical treatment," the statement said. "In this case, the plaintiffs are seeking to extend the inpatient treatment benefits beyond what is allowed in their current policies."

The insurers' argument that eating disorders should not be characterized as biologically based mental illness has been disputed by some leading researchers. The director of the National Institute of Mental Health wrote in a 2006 letter that anorexia has "a biological core, with genetic components."

Though the research in the field is inconclusive, it "leans in favor of a genetic predisposition," said Dr. Richard Pesikoff at the Baylor College of Medicine.

For Brian Smith, he says he hopes his lawsuit changes how insurance companies treat eating disorder patients. He claims that Janell, a teacher, knew that she would have to stay in the hospital at least a few more weeks. "That was her mindset until she found out she was being discharged," he said.

"She had everything going for her," he said.

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