Horizon Blue Cross to Expand Benefits for Eating Disorder Patients

Camryn Hansen

Contributor

0 CommentsPrint ArticleSubscribe

Today, US District Judge Faith Hochberg approved a class action settlement in Drazin v. Horizin Blue Cross which will require Horizon Blue Cross of New Jersey to expand benefits for 1.5 million patients with eating disorders. 566 Horizon patients whose coverage for eating disorders was previously limited will now recover about $1.2 million for treatment they received.

Horizon also agreed to treat any future eating disorder claims the same way it treats biologically-based mental illnesses (BBMI) such as schizophrenia—a move that will cost it an estimated $17.8 million. In so doing, the company will have to give up its current restrictions limiting treatment to 20 outpatient visits per calendar year and 30 days of hospitalization.

Medical experts have been saying for years that the long-term treatment Horizon has agreed to fund, particularly on an outpatient-basis, is necessary to address the physical and psychological causes of the illness. Most of the patients are young women.

Hochberg said the settlement, besides being fair, adequate and reasonable as required by law, will help "young people caught in a world they do not understand." -Henry Gottlieb, New Jersey Law Journal

In January 2010, when the U.S. Mental Health Parity Act goes into effect, all carriers will have to provide BBMI coverage for eating disorders to patients in employer-sponsored group health plans when employers have 51 or more employees. Small group and individual plans will be exempt from this requirement.

Considering the relatively higher costs of individual health insurance plans for women, it seems absurd that individual plans will not be required to offer this kind of coverage for patients (mostly young women) with eating disorders. If for years, medical experts have been deeming it necessary for these patients to receive prolonged outpatient treatment to recover, why is this kind of treatment not covered by insurance carriers except in special employer-sponsored circumstances?