Even with a federal mental health parity law, people suffering from an eating disorder often struggle to get adequate coverage and get kicked out of their treatment early, due in part to insurers’ shallow understanding of the illness’ physical and mental properties and ambiguity about what qualifies as “medically necessary” therapy.
But that will no longer be the case in Missouri. Last week, Missouri Gov. Jay Nixon (D) signed a bill that explicitly states the types of eating disorder treatments insurance providers must cover. The new law builds on the mental health parity law by expanding the definition of “medically necessary” to include mental health treatment. It will also ensure that weight no longer serves as the sole determinant for whether someone may continues treatment. Insurance companies have until 2017 to implement the changes.
Years before the law’s passage, family members of Missourians receiving eating disorder treatment often complained of premature halts to treatment and high out-of-pocket costs for counseling sessions — which experts call essential in addressing the underlying mental health issues and preventing a relapse. Advocacy groups, like the National Eating Disorders Association (NEDA), applauded the legislative milestone and expressed hope that other states follow suit.
“The victory comes following a seven-year process, previously held up by insurance company opposition and cost concerns,” NEDA wrote in a press statement in May shortly after Missouri’s State House of Representatives approved the changes, outlined in Senate Bill 145.
“Many states have Mental Health Parity Laws in place, which in theory should require the coverage of eating disorders by insurance companies. However, because the laws are vague they are left up to interpretation by the insurance companies who continue to deny care. By defining what the Standards of Care Guidelines are for eating disorders, according to the APA, insurance companies would be less likely to get away with denying care,” the statement read.
Eating disorders — defined as any psychological condition characterized by abnormal eating habits — affect nearly 24 million people of various ages and demographics in the United States. The most prevalent disorders include anorexia, bulimia, and binge eating disorder, all of which may be fueled by a desire to control one part of an otherwise hectic life. Contrary to the beliefs of some, people don’t develop eating disorders suddenly; rather, the issue typically develops over time and in tandem with a depressive disorder.
If left untreated, eating disorders often lead to muscle loss or weakness, severe dehydration, tooth decay, inflammation of the esophagus and gut, and high blood pressure and diabetes. Experts say failing to address the mental health care aspect could lead the suicide of patient who may hate the weight that he or she achieved. Such urgency hasn’t convinced insurers to close that coverage gap. Today, only one in 10 people suffering from a mental disorder receive help. In that group, 35 percent enter a medical facility and 50 percent are diagnosed as depressed.
While the process of treating an eating disorder and addressing the mental health issues often varies between patients, experts say that stays in treatment centers usually amounts to at least six months. According to NEDA, the ideal plan for those suffering from an eating disorder combines medical care, mental health services, nutritional therapy, and a team of specialists — a primary care doctor, a therapist, a psychiatrist, and a dietitian.
The 2012 mental health parity law by itself couldn’t have taken into account the nuances of therapy, which allowed insurance companies to make their own interpretations about what constituted as “medically necessary” — perhaps out of a desire to save money. On its blog, the Gall and Gentry Law Group said that insurers often go to great lengths to minimize costs, even sending an independent medical professional to examine the patient’s physical progress and estimate a discharge date that fits insurers’ goals.
Advocates and lawmakers saw insurance companies’ efforts to stay in the black firsthand throughout the years-long negotiation process for the bill when they kept raising the issue of future cost burden. Though no formal analysis has been carried out to estimate the burden it would place on the private sector, proponents of the change say the costs to provide the treatment as outlined in the Missouri law should be minimal.
But Missouri State Sen. David Pearce (R), the sponsor of the bill, said that the legislative changes will ultimately lower costs by ensuring that insurance companies proactively act to prevent future hospitalization or death. He told MissouriNet.com that couldn’ have happened under the status quo.
“We have seen patients who have declined, and some who have even died,” Pearce said. “The patient going through eating disorders would be in a hospital or a residential treatment facility, and once they reach a certain weight then they were dismissed, or perhaps maybe their organs had started functioning at a certain level, then they were dismissed.”