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Anorexic's mom sues insurer
She contends
her teenage daughter's disorder is biologically based
Thursday,
November 09, 2006
BY CAROL ANN
CAMPBELL
Star-Ledger
Staff
The mother of a teenager who was
denied insurance coverage for long-term anorexia treatment filed a
class-action suit yesterday against Horizon Blue Cross/Blue Shield
of New Jersey.
Dawn Beye of Wayne claims that eating
disorders such as anorexia and bulimia are biologically based mental
illnesses that should be covered under New Jersey law and under her
contract with Horizon. The company disagrees, noting that an
independent review sided with it and concluded "that we were
correctly applying the law and our contract," said spokesman Larry
Altman. He said that under New Jersey law, anorexia is not
biologically based.
Beye's battle has brought together other parents of children with
eating disorders, and the group is pushing for better insurance
coverage. Some 40 people met with Beye last month in Wayne and many
told stories of dangerously thin children, usually daughters, with
severe physical effects of anorexia, such as irregular heartbeat,
kidney damage and serious electrolyte imbalances.
"I want to see that everybody in New Jersey who has Horizon and has
these challenges gets the treatment they need and deserve," Beye
said yesterday after filing the suit in U.S. District Court in
Newark.
Horizon has maintained that anorexia is not biologically based and,
as a result, the insurer has limited coverage to 30 inpatient days
and 60 outpatient visits. New Jersey law requires insurers to cover
mental illness the same way that physical illness is covered. The
law refers to "biologically based mental illness" and says these
diseases include, but are not limited to, schizophrenia, bipolar
disorder and depression.
Beye and her attorneys, David A. Mazie and Eric D. Katz of Roseland,
cite eight prominent experts in the field of eating disorders who
contend anorexia is biologically based.
"If eating disorders are not biologically determined, why are there
now efforts to identify the specific genes involved?" wrote Emmett
R. Bishop Jr., a physician at the Eating Disorder Center of Denver.
Mazie said yesterday he does not know how many people would be part
of the class. He speculated it could include hundreds or even
thousands.
Beye said the cost of her daughter's treatment so far this year has
exceeded $200,000.
In a statement, Horizon said the insurer has an obligation to its
3.2 million members "to not pay for benefits in excess of those
contracted for any member because this results in higher costs and
higher health insurance premiums for all other members."
Carol Ann Campbell covers medicine. She may be reached at
ccamp bell@starledger.com or (973) 392-4148. |
