It is well known that certain individuals, usually young women, develop eating disorders which eventually affect their health. In fact, anorexia nervosa or bulimia nervosa, if left untreated often result in death. Young women suffering from these disorders require intensive psychological and nutritional intervention that often takes years.
Aetna, and several other carriers, have placed arbitrary limits on the number of treatments that these patients can seek. In Aetna’s case the limitis 20 outpatient visits per calendar year and 30 days of inpatient benefits. These and other policy restrictions often inhibit eating disorder sufferers from seeking treatment, as they know it is expensive, and they do not believe the carriers will cover all the session in the end.
A class action suit was brought against Aetna in New Jersey, DeVito v. Aetna Inc., civ-070-418, seeking to require Aetna to extend the same level of benefits it does for “biologically based mental illnesses,” such as schizophrenia, to eating disorders which Aetna simply characterized as “non-biologically based.”
In a monumentalstep forward, Aetna has now settled this class action by agreeingto”cover claims submitted [by its] insureds for the diagnosis, care and treatment of eating disorders in the same manner as biiologically based mental illnesses.” Though Aetna has made a significant concession on this topic, the details of how far the new coverage recognition will apply is still uncertain. Aetna maintains that this coverage will be available in all “fully insured” plans.Those are plans funded by employers. As to whether Aetna’s newcoverage policywill trickle down to individual policies or non-ERISA based plans is entirely uncertain.
This is the first time that a carrier has placed eating disorders on a parity with other “biologically based mental disorders.” In doing so, it is expected that many individuals suffering from anorexia or bullima will finally come forward and obtain the treatment that they so desparately need.
Finding the words “magnanimity” and “insurance carrier” hard to reconcile, it appears that Aetna may have been motivated by certain legislation now before Congress seeking to provide equitable treatment for those suffering from eating disorders.