For the Meiskins that meant long-term, residential care for their daughter at Avalon Hills. But while the decision to enroll Marisa was an easy one, paying for it threatened to sap their savings: In a scene that experts say plays out hundreds of times a month across the country—sometimes with tragic consequences—the Meiskins learned that their insurance company, Aetna, Inc., provided coverage for only 30 days of inpatient treatment a year. After that the Meiskins—Cindy, 45, is a personal trainer and her husband, Jeff, 46, a real estate developer—would be responsible for footing the $850-a-day bill. As Lynn Grefe, CEO of the National Eating Disorders Association, notes, "To pay for treatment, families use their savings. They take out second mortgages. They go broke."
But now families like the Meiskins are fighting back, challenging mental-health laws that are supposed to guarantee equal care, so that, say, someone who suffers from schizophrenia is entitled to the same coverage as someone who has cancer. In most states, however, these laws do not apply to anorexia and bulimia. The reason? Until recently, eating disorders were not considered to be biologically based conditions that could be treated in the same way as other mental illnesses (see box below).
But in a class-action lawsuit against Aetna, the Meiskins argued that eating disorders are biologically based—and on May 22, in what some experts are calling an important victory, Aetna agreed to pay back the Meiskins the more than $60,000 they ended up spending out of pocket to pay for an additional four months of Marisa's treatment. (To make sure they'd be able to keep Marisa at Avalon Hills for up to a year if needed, the couple, who have two other daughters, took out a line of credit against the equity in their Robbinsville, N.J., home.) Aetna also agreed to pay denied eating-disorder claims to 100 New Jersey families dating back to 2001, as well as future eating-disorder claims from existing, fully insured Aetna customers.
In a statement, an Aetna spokesman said the company believes the settlement "is consistent with Aetna's goal of providing comprehensive, affordable coverage and service for all of its members." And although the resolution affects only Aetna clients in New Jersey, Diane Robertson of the Emergency Care Research Institute, a nonprofit that tracks medical legislation, is among those who feel the case could have national ramifications. "Aetna finally woke up," she says. "Now there will be huge pressure on other insurers to cover eating disorder treatments."
Already there has been an effect: In the wake of the Meiskins' settlement, the New Jersey state senate is considering legislation that would mandate equal insurance coverage for anorexia and bulimia. Still, even in states where equal coverage of eating disorders is already required, doctors and insurers are sometimes at odds over what constitutes medically necessary treatment. Although a 1995 study in the American Journal of Psychiatry found that anorexia has the highest death rate of any mental illness, "the insurance company doesn't see that," says Gail Schoenbach, executive director of the F.R.E.E.D. Foundation, a nonprofit that helps families pay for anorexia treatment. "They pay for the hospitalization, which gets a patient stable; then the patient is sent home. But the issues of the illness aren't addressed." Counters Susan Pisano, spokeswoman for America's Health Insurance Plans, an industry association: "[Coverage] is based on what's shown to be safe and effective."
Brian and Mary Smith allege that, if that were truly the case, their daughter Janell would still be alive. The Smiths—who are set to go to trial on June 30 against their insurer, Magellan Health Services—claim company officials illegally ordered the discharge of their daughter from the hospital even though, at the time, she weighed just 77 lbs. "Her doctors told us she had to be 85 lbs. before she could leave," says Brian Smith, 63. "Janell told me, 'Dad, I just can't get on the scale and have the first number be an eight.' I thought, 'Here's a serious sign she's not ready.'" Less than a week after exiting the facility, Janell, 26, committed suicide. (A Magellan representative could not comment on the specifics of the case because of patient-confidentiality laws but says, "We are confident that when all the facts come to light, our actions will be found to have been entirely appropriate.")
Five years later "life goes on, but it has never been the same," says Brian, who was divorced from Mary, 60, in 2006. On weekly visits to Janell's grave site in El Cajon, Calif., he polishes his daughter's headstone, recalling "how she used to say, 'How's my favorite dad?'" he says, choking back tears. "And I'd say, 'That's because I'm your only dad.'" The one thought that helps him to carry on, he says, "is to prevent this from happening to someone else."
It's that same sentiment that drove the Meiskins to take legal action. "I thank God every day that we were able to pay [for Marisa's treatment]," says Cindy. "But this is for all those people who can't. No family should have to lose a child or not be able to treat their child." That's something Cindy is reminded of every time she looks at Marisa, whom she describes today as a "beautiful, healthy girl." As Marisa preps to be a high school senior this fall, she admits her eating disorder is something "that's always going to be there. I think about it every day." Still, she is relishing her second chance. "I'm just living," she says, "a normal teenage life."
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