Eating disorders and mental health parity

23rd June 2008

Eating disorders and mental health parity

posted in Eating Disorders, Legal Issues, Mental Health |

CBS has a report on some sad news to come out of San Diego. Twenty-six year old Janell Smith was hospitalized in January this year for anorexia. A feeding tube kept the severely underweight woman alive. But three weeks later just as Janell seemed to be improving, her father said he got a call from Janell’s health insurance provider, Magellan Health Services. Brian Smith tells CBS News,

“The counselor said, ‘Nobody’s talked to us about next-step strategies. In fact, we don’t support this. The insurance company is pulling the plug.’ That was her words.” Janell was released from treatment. Days later, her family says, guilt-ridden in the wake of an eating binge, Janell ingested a toxic combination of Tylenol, vodka, and cocaine. She overdosed and died.

“Had she been able to get the care she needed,” says her sister, “and had the doctors said, ‘You know, she’s at a good place, and she can go into an outpatient program,’ I believe she’d be with us today. I really do.”

Magellan denies that, countering that Janell discharged herself and that her doctors didn’t request extended hospitalization for a woman who weighed just 70 pounds and required the use of a feeding tube. The company adds that it was the family’s responsibility to ask for more coverage (shouldn’t this responsibility fall on doctors?), that Janell’s coverage had simply expired and that, had the family asked for more, Magellan would have granted it. Anyone who’s ever battled both an eating disorder and health insurance rules and regulations would know the latter part is simply not true. It’s often as large of a battle to get an insurance company to pay for treatment as it is to recover from the disorder itself. Shame on you, Magellan. Shame on you.

This is why the Paul Wellstone Mental Health and Addiction Equity Act (H.R. 1424) is so, so important. People are literally dying while insurance companies continue to discriminate against mental health just to save a few bucks on their bottom lines. I urge you to help support this bill and others that help promote eating disorders for what they are: a serious, mental illness that can be as deadly as cancer and therefore deserving of equal coverage under law.

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This entry was posted on Monday, June 23rd, 2008 at 10:20 am and is filed under Eating Disorders, Legal Issues, Mental Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

1 On June 23rd, 2008, Tia said:

Oh that is so heartbreaking.

I wasn’t aware of the Paul Wellstone___ act, or the bill for the ED. I will definitely be calling on that one.

It just makes me sick to my stomach.

posted on June 23rd, 2008 at 11:17 am

2 On June 23rd, 2008, nuckingfutz said:

You know, it’s stories like this that make me ashamed to admit that I used to work in the health insurance industry. I was never one of the ones that got to make decisions on people’s healthcare (I was a lowly data entry tech), but still.

I’m definitely supporting the bill.

posted on June 23rd, 2008 at 11:58 am

3 On June 23rd, 2008, bookwyrm said:

It bothers me less that “health” insurance doesn’t cover mental health (it doesn’t cover dental health either) and more that some illnesses only diagnosable by looking at symptoms are covered and some aren’t. There chronic are physical illnesses with no physical test that are covered, whereas mental health isn’t covered at the same level because there’s no physical test and treatment is ongoing. Seems slightly skewed to me. If you want to separate out dental, physical, and mental health policies, that’s fine, but covering psychosomatic pain and not covering anorexia is a ridiculous distinction.

posted on June 23rd, 2008 at 12:04 pm

4 On June 23rd, 2008, Brynne said:

That’s horrible and sad and makes me so glad that my parents intervened with my own eating disorder before it got to that point in the first place…but insurance pulling…? That’s so ridiculous! It’s not only symptomatic of the societal trend of seeing eating disorders as a self-inflicted disease, but it also brings to light just how corrupt those companies are.

I’d like to mention, however, how the media coverage of the story irritates me…how they start their story with her sister saying what a wonderful, kind, good person she was. I’ve never seen a story about something bad happening to a person where they don’t pull that, and it’s probably true, but it still annoys me, because that’s just not the point and not really relevent.

That’s my $0.02.

posted on June 23rd, 2008 at 7:32 pm

5 On June 23rd, 2008, vicky smith said:

I’m behind the bill heart and soul, it’s a little different in the uk but still damn hard to get treatment and past waiting lists if you can’t pay up front. And even then I doubt it’s easy.

Insurance companies have got to take notice and not turn their backs on eating disorder patients anymore.

Vx

posted on June 23rd, 2008 at 7:36 pm

6 On June 23rd, 2008, Gerald said:

hi bill, i support U a MILLION PERCENT.

posted on June 23rd, 2008 at 8:49 pm

7 On June 23rd, 2008, Rachel said:

Brynne, I also wish more media outlets would be a bit more sensitive to the issue of eating disorders and not report specific numbers or BMIs in stories on individuals with them, especially in cases where the person has died. For many with an eating disorder, death or serious illness requiring hospitalization is the ultimate triumph of a successful disorder. By reporting Janelle’s low weights, ABC news is only providing fodder for scores of pro-ana sites worldwide.

posted on June 23rd, 2008 at 10:06 pm

8 On June 24th, 2008, Brynne said:

that occurred to me as well…and speaking of which, I just read a book called “Girls: A History of Growing Up Female in America”, by Penny Colman. It is fantastic and I highly recommend it, except for one thing…it talks about the beginnings of the “thin” days, with the flappers in the 1920s, and details the story of a girl who at 14 decided she wanted to lose some weight and ate 150 calories a day for weeks….

It doesn’t talk about her weight, but what irritated me (HIGHLY) is the fact that, although the tone of the paragraphs (it was just a page and a half or so) was not exactly encouraging, the author never explicitly states that THIS IS A BAD THING. I can just SEE some girl reading that and going “oh, that sounds like a good idea”.

posted on June 24th, 2008 at 9:31 pm

9 On June 24th, 2008, Moonlight0806 said:

I’m sure every state is different, but I’m from Oklahoma. Here the medical doctor and the medical facility is legally liable for releasing a patient that is a risk to themselves or others. That means if the hospital releases you with the knowledge that there is a good chance you will have continued destructive behavior, they are taking a risk of being sued for negligence and unethical practice. Why isn’t anyone focusing on the doctors that let her walk out the front door knowing full well that she was not healthy enough to survive on her own. It sounds like they are getting to slip into the background by directing all blame to the insurance company. I’m not supporting the insurance company but I am saying he medical facility was just as greedy and ruthless when they kicked her out the front door the second the money stopped coming in. These people had everyday contact with her and could see just how sick she was, yet they ushered her out the front door and turned their back. Why isn’t anyone on the news or on the net talking about the unethical practices of turning away patients when they are dependent on care. Shouldn’t we be calling the hospital and supporting legislation that would require them to solidify care plans before releasing sick patients? I would like people to stop confusing health care with the insurance industry. We argue that insurance should pay these ridiculously high bills but we never stop to ask why we are charged so much in the first place. No one really believes that the hospital really pays $5 per Tylenol when they go to the emergency room or $15 for an ace bandage, so why do we accept being charged this much? Why do we have laws protecting our citizens from being being taken advantage of by a monopoly or during a natural disaster, but ignore when they are taken advantage of during a medical crisis when they have no other choice but pay the high mark up or die.

posted on June 24th, 2008 at 11:43 pm

10 On June 25th, 2008, Cassandra said:

We need overall better mental health coverage in the US, not just for eating disorders.

I think one part of insurances refusing to treat some types of mental illness has to do with the fact they are viewed as “brought on by the patient”, rather than being organic in nature. You can’t just cut the eating disorder out of the patient like you can a tumor out of someone battling cancer. There is no quick fix or promised fix for mental illness.

The treatment of mental illness is expensive and frequently chronic with no absolute cure. It is a financial risk or just a “poor investment”, which is going to show how society as a whole is valuing possession over the person. The person can die and their gold watch that they left behind be of more value to future generations than the lessons they taught the survivors — it is really stupid little value society places on human life.

Ultimately she committed suicide. The insurance pulling the plug on treatment is not entirely to blame because therapists and doctors could have been treating her for the depression in addition to the eating disorder (who says they weren’t) or the family could have paid for some of her treatment out of pocket or she could have applied for low-income facilities/ religious group homes that specialize in the treatment of mental illness… the list goes on — the insurance cannot be blamed entirely for her taking her own life.

Just because the insurance pulls the plug, doesn’t mean the fight is over. There are other options out there, including psychiatric disablity. She might not have had the time line to work through all of these options… but I don’t feel comfortable placing complete blame on the insurance for her death. Her caregivers could have done some “homework” too and possibly put more effort into helping her than they did — denial is the worldest deadlest drug! It kills…

posted on June 25th, 2008 at 10:26 am

11 On June 30th, 2008, Wellstone Action said:

Thanks for the blog post on this critical issue, and Janell’s preventable death is tragic. It is very similar to the story of Anna Westin (http://www.annawestinfoundation.org/anna_story.html)who also died when the insurance company denied her treatment. Anna’s mother, Kitty, has been a tireless advocate for the Wellstone bill, along with Paul Wellstone’s son, David.

We’ve just received word that the Wellstone bill is very close to passing, but Representatives and Senators need to find the money to pay for it. Please join our email list at http://www.wellstone.org for more updates and to take action on this issue, ending discrimination against people with mental illness.

posted on June 30th, 2008 at 10:37 am

12 On July 1st, 2008, Avery said:

It wasn’t this January, it was in 2003. Janell was a childhood friend/ neighbor of mine. Thanks for adding her story. She was beautiful and kind and talented and deserved so much! I pray her parents get the justice they deserve for Janell and others like her. Even though time has gone by, one never gets over the loss of a child. They’re such a wonderful family and they at least deserve some closure. Three of us on the same street have had serious battles with eating disorders, one didn’t make it. I know the two of us that are left, will never stop fighting for her sake.

posted on July 1st, 2008 at 3:55 pm

13 On July 1st, 2008, Rachel said:

Thanks for the clarification, Avery. The article didn’t make that clear. I’m sorry for your loss.

posted on July 1st, 2008 at 4:15 pm

14 On July 1st, 2008, J said:

Go bill go! (I’m delurking just for this, because it’s that important. And I’m a week late, but never mind that.)

bookwyrm and Cassandra, I am totally with you — the discussion has to be about mental health parity in general, not just these headline-grabbing examples of anorexia. While of course it’s vitally important that extremely thin anorexia patients have access to treatment, ED sufferers who don’t fit that profile need to have access, too. The focus on “she only weighed xx pounds!” not only objectifies and idealizes the disease, but it also kinda misses the point, doesn’t it? Eating disorders are mental illnesses. They shouldn’t just be an exception to the overall stigma against recognizing and treating mental illness. But maybe because they can be the wedge that makes mental health parity possible.

posted on July 1st, 2008 at 5:45 pm

15 On July 1st, 2008, Avery said: