Eating Disorders, Health Insurance Abuses, and the Destruction of Marriages, Families and Lives
According to the National Association of Anorexia Nervosa and Associated Disorders, eating disorders have the highest mortality rate of any mental illness; up to 24 million people of all ages and genders suffer from an eating disorder in the United States; only one in ten with eating disorders receive treatment; only 35% of those treated get their treatment at a specialized facility for eating disorders; and almost 50% of people with eating disorders meet the diagnostic criteria for depression.
The most common causes of death secondary to eating disorders are heart failure, organ failure, malnutrition and suicide. 20% of people suffering from anorexia will prematurely die from complications related to their eating disorder, including suicide and heart problems. The statistics go on and on. 86% of those suffering with eating disorders report the onset of an eating disorder by age 20, and 43% report onset between the ages of 16 and 20. Anorexia is the third most common chronic illness among adolescents. And 95% of those who have eating disorders are between the ages of 12 and 25.
Eating Disorders are categorized as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. (DSM-V). They are also listed as an impairment which may qualify an individual for Social Security disability. The Journal of Labor Economics published by the University of Chicago, confirms what common sense tells us: that mental illnesses affect an individual’s ability to marry or stay married and lower the number of children which an afflicted person may have. And it has long been known that broken marriages and dysfunctional family backgrounds in tandem with mental illness and socioeconomic adversity contribute to suicide among young people. BMJ2002 325.74 (July 13, 2002).
If an eating disorder victim can be identified early enough and receive evidence-based treatment, the outcomes are good and the cost is relatively modest. On the other hand, if the disease gets out of control and is not treated properly, the costs of treatment can be catastrophic with a very poor or tragic outcome. Inpatient hospital or residential care is extremely expensive, averaging well above $1000 per day. Very often, a patient who was not fortunate to have been diagnosed early with early intervention may require upwards to six months of inpatient or residential treatment. Naturally, insurance companies are highly motivated to monitor such a patient’s treatment plan and the results closely, often on almost a daily basis, in order to get the patient discharged as soon as possible. This process is called the “utilization review technique,” and involves a medical professional who is hired by the insurance company. This individual basically second-guesses the patient’s treaters but has no doctor-patient relationship with the patient and no liability for bad advice. This individual’s only loyalty is to the insurance company. In operation, what this means is that every few days the patient’s continued treatment is in jeopardy. The effect on the patient, who at best is ambivalent about getting treatment, and the patient’s family, is to ratchet up the stress levels every day as an insurance company tries harder and harder to get the patient out of treatment.
In their efforts to obtain an early discharge, the insurance companies focus on the physical effects of the disease rather than on the disease as a mental illness. Thus, for example, insurance companies push for the early discharge of a patient from an eating disorders inpatient hospital or residential care facility when the patient achieves 80% of her ideal body weight. Discharge at this point is often not only premature; it may be extremely dangerous because the patient may be suicidal, not just because depression and suicide potentials go along with the disease, but also because she hates herself at the weight she has achieved. In pursuing their goal of discharge, health insurances companies, employing the “utilization review technique,” are not dealing with the disease in a scientific manner.
At this time legislation is pending before the Missouri General Assembly calculated to make health insurance companies do what Missouri law already mandates. House Bill 1493 and Senate Bill 769 are the pending bills and are sponsored by Representative Rick Stream and Senator David Pearce. Section 376.1550 of the Missouri Revised Statutes requires insurance companies to cover treatment for mental illness as they are defined by the DSM-V. The bills before the General Assembly require coverage for eating disorders in compliance with Section 376.1550. And they go further: The bills require coverage for treatment according to the treatment guidelines currently approved by the American Psychiatric Association. How will this bill help families and patients? It will compel insurance companies to abandon their pseudo diagnostic criteria and to cover the treatment prescribed by the patient’s doctors.
The legislation now pending before the Missouri General Assembly will not only bring insurance companies into line with Missouri law. It will bring them into line with what the Social Security Administration has long acknowledged. Listing 12.00D.12 of the Social Security Administrations regulations about disability benefits for mental impairments states the following about eating disorders:
“12. Eating disorders. In cases involving anorexia nervosa and other eating disorders, the primary manifestations may be mental or physical, depending upon the nature and extent of the disorder. When the primary functional limitation is physical; e.g., when severe weight loss and associated clinical findings are the chief cause of inability to work, we may evaluate the impairment under the appropriate physical body system listing. Of course, we must also consider any mental aspects of the impairment, unless we can make a fully favorable determination or decision based on the physical impairment(s) alone.”