A Whole New Battle

With out-of-pocket costs for inpatient medical care ranging anywhere from $15,000 to upward of $30,000 a month (Beye says her daughter's program costs them $1,500 a day), it’s not surprising her battle is not the first to be brought to court, and will likely not be the last. The most notable case was in 2001, when Blue Cross and Blue Shield of Minnesota agreed to pay $8.2 million to the state and expand its coverage of eating disorders to settle a suit involving treatment denied to a 21-year-old anorexic woman who committed suicide. Beye’s lawyers hope her case will set a similar precedent.

Blue Cross of New Jersey, meanwhile, contends that while the state's mental-health law requires insurers to cover mental illnesses the same way it covers medical illnesses, it does not specifically list eating disorders under this category. What it does list are schizophrenia, obsessive-compulsive disorder, psychosis, major depression “and others.” Because of that distinction, Blue Cross limits its coverage to 30 days of inpatient and 60 days of outpatient care, noting in a statement that the company’s decision in the Beye case was reviewed and upheld by an independent commission and that "any argument that anorexia is a biologically-based mental illness is contrary to its historic medical classification and New Jersey law.” Beyond the interpretation of the law, Blue Cross spokesman Thomas Rubino says that while there have been "a number of studies over the years that point to environmental and other factors [as causes of anorexia], there are no studies that have conclusively proven that [anorexia nervosa] is a biologically-based mental illness.”

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Leading experts in the field—and even the federal government—however, clearly counter that claim. In a letter to the National Eating Disorders Association last month, Thomas Insel, the director of the National Institute of Mental Health, states that “anorexia nervosa is a brain disease” and while its "symptoms are behavioral” the illness “has a biological core.” The NIMH Web site also lists numerous studies that attest to that statement. “Anorexia has the highest death rate of any mental illness, and for companies to hide behind what’s an interpretation of New Jersey’s law is very self-serving,” says New Jersey state Sen. Joseph Vitale, chairman of the state Senate's health committee and author of a bill to mandate coverage of eating disorders.

Dr. Cynthia Bulik, a lead eating-disorder researcher who has used twin studies to look at genetic contributions to anorexia, says that though environmental factors do indeed play a roll in the manifestation of anorexia and bulimia, the biological contributions are clear. A clinical psychologist and director of the eating-disorders program at the University of North Carolina, she says that eating disorders are being held to a different standard of proof than other complex mental illnesses for which insurers will “happily pay.” Bulik says, “We would like to see them hold schizophrenia, asthma, bipolar disorder, autism, etc., to the same standard. All of the research in these areas point definitely to biological causes, but [as in the case of anorexia, they] show that environment can trigger the disorders.”

Bulik adds that insurance companies may not be thinking in the long term as they determine coverage plans for eating-disorder patients, as the lasting effects of anorexia range from osteoporosis to severe gastrointestinal problems. In addition, women who are taken out of treatment early have a much higher rate of reoccurrence. “If insurance companies would help families when their children are beginning to show signs of disordered eating before it becomes a full-blown eating disorder,” they would save money and the anguish and frustration faced by families, says Grefe of the National Eating Disorders Association. “If they could get interventions early, they may not even need inpatient treatment.”