Slim Insurance Coverage for Anorexics

It’s no secret that managed care has made essential medical coverage difficult to obtain. But HMO’s are especially tough on anorexic patients.

A March 27, 1999 Wall Street Journal article, reprinted online by the Kansas City Star reported that insurers frequently refuse to cover the long hospital stays anorexics often require. The article quoted Dr. Walter Kaye, a professor of psychiatry and an anorexia specialist at the University of Pittsburgh, as saying that “we’ve had people die” because anorexics could not be admitted to the hospital due to insurance problems.

According to the article, a person 30 pounds underweight can remain hospitalized for three months. The Journal cited findings of William T. Howard of Johns Hopkins University stating that patients need to be fed in the hospital until their weight is 90 percent normal. Patients below that standard who are discharged have a tenfold risk of relapse. The Journal also noted that each decade of chronic anorexia increases a patient’s chances of dying by five percent. Ailments of long-term anorexics include heart, liver, and kidney problems, the Journal reported.

The story of 18 year-old Emmy Pasternak, reported on May 8, 1998 by the Associated Press, is particularly heart-wrenching. Pasternak was hospitalized five times for anorexia and continues to suffer from heart problems and osteoporosis, according to AP. The article reported that Pasternak’s hospitalizations were “overshadowed by worries about insurance and money.” Her year-long stay in a San Diego clinic cost over $138,000 and depleted her parents’ entire life savings.

Denial of coverage for anorexia nervosa is part of the wider crisis in the treatment of psychological disorders. Because anorexia is considered a mental illness, it is subject to insurance caps. Some HMO’s have caps for anorexia as low as $10,000, according to the AP. The AP noted that anorexia takes an average of three to four years to successfully treat.

What should an anorexic or her family do when she is denied coverage? Drs. Kelly Kearfott Hill and Michael Maloney of the Children’s Hospital Medical Center in Cincinnati stress better physician documentation of life-threatening symptoms, as reported by . If you are denied coverage, the Journal article suggests speaking with a supervisor or your plan’s medical director and supporting your claim with information from your doctor. In addition, it recommends consulting an attorney if appeals are not successful.

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