Critical Care

The settlement, which was agreed upon by both parties but still needs court approval to proceed, may be a breakthrough for advocates of eating disorders. But some critics contend it's still unlikely to change the financial bottom line. With out-of-pocket costs for inpatient care averaging $25,000 a month (and average stays at three to four months), according to Grefe of NEDA, the $2,500 each family will get in the settlement won't even begin to cover what some have paid out of pocket already. Aetna does treat eating disorders to some extent: 30 days of inpatient care and 20 days outpatient is a common coverage plan; the company also has a pilot program that pairs families with nurses to coordinate aftercare. But it's those limits that often cut treatment short. And though the company will put eating disorders on par with other biological illnesses for the moment (thus bypassing those limits), they don't plan on implementing that policy on a permanent basis. "We have covered and continue to cover treatment for eating disorders," says Aetna spokeswoman Cynthia Michener. "But under the [state] statute, for people not included with the [class action settlement], we're still going to comply with the law."

For the moment, the fight for insurance coverage is as strong as ever. There's another class action suit in New Jersey, against Horizon Blue Cross Blue Shield, and the lawyer in that case, Eric Katz, has filed a court objection to the Aetna settlement, arguing that its limited terms undermine his case for full and unlimited parity. (He points out that only 100 people will receive coverage for past claims under the Aetna settlement; statistics, he says, show that more than 25,000 were denied coverage over the past seven years.) "On its face, [this settlement] looks like it provides some kind of relief," says Katz, who is still signing on new members for his case against Horizon. "But in reality, it gives up the rights of everybody."

Last week, the House and Senate came up with a compromise mental health parity bill that reconciles the two versions each had approved. If passed, the new law would prohibit discrimination between mental and physical illnesses by insurance companies. But the bill doesn't list eating disorders explicitly, leaving many families to sift through state laws and endless insurance rules to determine what's covered, and for how long.

Most states do have their own parity laws, but only about a dozen specifically include eating disorders as part of that parity, according to a 2007 report from the National Women's Law Center. New Jersey, meanwhile, is one of seven states with limited parity, meaning its laws contain exemptions for illnesses that are not considered "biological." New Jersey lists illnesses such as schizophrenia, obsessive-compulsive disorder, psychosis, major depression "and others" under that definition, but not eating disorders explicitly. And whether or not anorexia and bulimia are indeed one of those "others," it's easy for companies to argue otherwise. Horizon, which typically covers 30 days of inpatient care and 60 days of outpatient, defends its policy. Says company spokesman Thomas Rubino, "The argument that anorexia is biologically based is contrary to its medical classification and New Jersey law."

That's a line Dawn Beye, the leader in the suit against Horizon, knows all too well. Three weeks into her daughter's treatment for anorexia, which doctors say can take months, Horizon stopped paying. Her daughter came home and hit rock bottom. Ultimately, she checked into a private facility, and Dawn and her husband took out home-equity loans, tapped every savings account, and even depleted their childrens' college funds to pay for it. "We told [our daughter], 'We may not have the same house when you come home—but it's only a home.' The most important thing is that she gets the treatment she needs," says Beye.

To date, the Beyes' 18-year-old has spent 13 months in inpatient treatment, putting the special education teacher and her now ex-husband more than $250,000 in debt. And that length of stay is far from uncommon. Many anorexics enter treatment 30, even 40 pounds underweight, and it's impossible to safely gain more than two pounds a week, say experts. That means four months minimum—if things go smoothly.