Reversing a trial court decision, the U.S. Court of Appeals for the 9th Circuit ruled August 26 that Blue Shield of California must cover treatment for all “medically necessary treatments” relating to mental disabilities on par with physical disabilities under the state’s Mental Health Parity Act.
The act, passed by the California legislature in 1999, requires insurance companies to provide coverage for nine “severe mental illnesses” under the same “financial terms and conditions as it does for physical illnesses. Many other states have enacted similar laws.
The case centered on Jeanene Harlick, 37, a North California resident who had struggled with eating disorders for more than two decades. She had fallen below 65 percent of her ideal body weight and needed treatment for anorexia nervosa, a disorder that forces people to obsess about their weight and requires the insertion of a feeding tube as part of the treatment. Eating disorders are listed as a “severe mental illnesses” under the law.
After trying unsuccessfully to find a center in California to provide treatment, Harlick spent 10 months at the Castlewood Treatment Center in Missouri beginning in April 2006.
Blue Shield of California’s insurance plan specifically states that it does not provide coverage for residential treatment, such as that which Harlick received at the Castlewood Treatment Center. However, Harlick asserted that her doctors told her the treatment would cover the treatment. Harlick filed a complaint with California’s Insurance Commissioner, prompting the current lawsuit.
The 9th Circuit ruled that Harlick’s treatment was medically necessary. Therefore, Blue Shield’s exception for residential treatment was superseded by the law’s requirement to provide treatment for all “medically necessary treatment” for certain mental disabilities.
The other mental illnesses that insurance companies must cover under the law are schizophrenia, schizoaffective disorder, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, autism, and serious emotional disturbances in children and adolescents.