Critical Care

Marisa Meiskin had been to specialists and therapists—even spent a month in a New Jersey treatment facility. She'd lost friends over her obsession with her weight, and quit school activities. Finally, her pulse got so low that her doctors feared the 16-year-old's heart might stop. "The illness got to be bigger than her. It was her life and it controlled her," says her father, Jeff.

That's when Jeff and his wife, Cindy, of Robbinsville, N.J., knew they had to do something drastic—whatever the cost. They checked their anorexic daughter into a private treatment facility some 2,500 miles away from home in Petersboro, Utah, for an intensive five-step program against a backdrop of picturesque rolling hills and complete with an equestrian program, yoga and music therapy. They liked the atmosphere, and hoped for the best.

Marisa spent the next four months there recovering, at nearly $30,000 a month. She graduated from the program last July. Today, say her parents, she's a happy, healthy teenager with a summer job. But she got that way with little help from her insurance company, Aetna. And her treatment sent the Meiskins digging deep into their pockets to cover the approximately $120,000 cost (including travel), of which Aetna covered about a quarter. "If she were there longer, who knows, we might have had to sell the house," says Jeff Meiskin. "But if it meant we got back our daughter, we'd do it."

Like most states, New Jersey law doesn't require insurers like Aetna to cover the cost of eating disorder treatment, despite the fact that some 11 million people are afflicted by eating problems, ranging from anorexia and bulimia to binge eating, according to the National Eating Disorders Association, a Seattle nonprofit. Rather, the law mandates coverage of mental illnesses considered to be "biologically based," a list that includes disorders such as schizophrenia and obsessive-compulsive disorder, well known to be products of genes, not just social or environmental forces like peers or parenting.

Anorexia, too, is biological, say many experts and some clinical studies. Thomas Insel, the director of the National Institute of Mental Health, has called it a "brain disease." But that's not the case when it comes to New Jersey law, which is worded in a way that excludes eating disorders from the list of biological mental illnesses that require coverage—leaving many patients out in the cold. "Wherever I go, I hear the same stories—families depleting their retirement accounts, going through life savings, taking second mortgages on their homes because insurance companies won't pay for their child's coverage," says Lynn Grefe, the CEO of the National Eating Disorders Association. "I don't think I can think of a state where I don't hear these stories, and families just don't know how to get out of this hole."

To get out of that financial morass, the Meiskins sued Aetna, and found nearly 100 other families willing to sign on to their claim. Now the Hartford, Conn.-based insurance company is willing to settle the case, paying the families $250,000 (to be split among them) for claims dating back to 2001 and covering future eating-disorder claims for people enrolled in fully insured plans by the beginning of September. "This is a landmark settlement we hope will change the way insurance carriers view eatings disorders," says the group's lawyer, Bruce Nagel. "It's the first time in the country an insurer has agreed to pay past denied claims."