New York Levies $1.6 Million Penalty for Wrongly Denied Eating Disorders Coverage

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[This is a press release from the National Eating Disorders Association. I don't typical just "rip and run" press releases, but I am for this, which I consider important and significant.]

NEW YORK CITY, Aug. 24 — The National Eating Disorders Association (NEDA) applauds New York Attorney General Eric T. Schneiderman and the New York Health Care Bureau for the milestone, mental health-parity decision announced yesterday, which awards a $1.6 million settlement against Buffalo-based HealthNow, New York, Inc.

The announcement follows the conclusion of an investigation which uncovered the wrongful denial of thousands of claims for outpatient psychotherapy and more than 100 claims for nutritional counseling for eating disorders. The investigation was launched under Timothy’s Law, which mandates that New York group health plans provide “broad-based coverage for the diagnosis and treatment of mental, nervous or emotional disorders or ailments … at least equal to the coverage provided for other health conditions.”

HealthNow will pay members for the wrongfully denied claims, revise its policies and will eliminate a controversial company mandate that subjected all psychotherapy claims to review following a member’s 20th treatment, a utilization review process not imposed on out-patient medical services.

“Insurers have a legal obligation to provide the same level of care to patients being treated for behavioral health conditions as they do for patients with other ailments,” said Schneiderman in a press release announcing the settlement. “Individuals confronting mental health conditions, eating disorders or substance abuse should not be denied coverage for the treatment they need and deserve.” 

Commented Claire Mysko, CEO of NEDA, “The National Eating Disorders Association has heard countless stories from families and individuals who have had to go to extreme lengths to afford life-saving treatment, emptying life savings and mortgaging their homes. Insurance coverage continues to be the biggest barrier to treatment for eating disorders—which are complex illnesses with the highest mortality rate of any psychiatric disorder. We are grateful to Attorney General Schneiderman and his colleagues who fought for those who have been long and wrongfully denied the right to treatment. We hope this settlement will lead the way in keeping insurance companies accountable nationwide.”

Eating disorders, which will affect 30 million Americans, require comprehensive treatment to address the mental, behavioral and physical components of the illnesses. Successful treatment may require working with a team of medical professionals, including physicians, psychiatrists, therapists and nutritionists. But there is hope and recovery is possible, particularly with early intervention and access to quality care.

NEDA works with advocates across the country to lobby for legislative reforms at both the state and federal levels. Comprehensive mental health-reform legislation is currently awaiting a vote in the U.S. Senate (S.2680), which, if passed, would ensure that eating disorder sufferers have access to treatment in every state. 

The National Eating Disorders Association (NEDA), headquartered in New York City, is the leading U.S. non-profit organization supporting individuals and families affected by eating disorders.


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