Hurdles to Recovery: How Health Policies Impede Treatment of Eating Disorders
By Karen Reed-Matthee

After struggling with anorexia for five years, Anna Selina Westin, of
Chaska, Minn., committed suicide at age 21. Her parents say their daughter’s death in February 2000 was a direct result of anorexia, and that one of the many roadblocks to her recovery was the lack of adequate coverage provided by her insurance company.

After her death, Anna’s family began advocating for improved access to inpatient and residential care for people with eating disorders. They approached late Minnesota Sen. Paul Wellstone and state Attorney General Mike Hatch for help. In October 2000, Hatch filed a lawsuit against Blue Cross and Blue Shield of Minnesota for delaying, denying and withholding mental health, chemical dependency and eating disorder treatment to Minnesota children and young adults.

The suit, settled in June 2001, resulted in improved access to care for Minnesota residents suffering from eating disorders and other mental health concerns. The Westin family received a private out-of-court settlement from Blue Cross/Blue Shield that they donated to the Anna Westin Foundation for the development of a residential treatment center for women with eating disorders in Minnesota.

The Sen. Paul Wellstone Mental Health Equitable Treatment Act, now before Congress, would require health insurance companies to provide the same coverage for any mental illness listed in the American Psychiatric Association manual, including eating disorders, as they do for physical ailments.

“It has overwhelming support, but it’s being held up by the House leadership,” says Jeanine Cogan, policy director for the Eating Disorders Coalition (EDC) in Washington, D.C. The EDC, made up of 21 organizations, including the Anna Westin Foundation, promotes federal support for people with eating disorders. Achieving mental health parity is the coalition’s biggest priority.

Prior to the proliferation of managed care, families would receive coverage for about 50 days of residential treatment a year, compared to an average of 15 days now.

“People are leaving treatment before they’re recovered,” Cogan says. “Some are coming back the following year. Providers are seeing the same patients again and again. It’s like a revolving door.”

Cogan says only a handful of states have good mental health parity laws now. They are Alabama, Arkansas, Connecticut, Georgia, Kentucky, Maryland, New Hampshire, Tennessee, Utah, Rhode Island and Vermont.

In Seattle, former NEDA board member Melissa Nielsen says unless families are well off, they have to scramble to pay for treatment. She has run a support group for families of children with eating disorders for 10 years. Members of her group have had to refinance their homes to pay for treatment.

“We are so grateful that our daughter got well,” Nielsen says. “She got well because we had the means to help her get well.”

The lack of insurance coverage for treatment of eating disorders is “tragic,” says eating disorders expert Dr. Craig Johnson.

“Health care reform is badly needed to help these patients receive adequate care.”

Dr. Doug Bunnell, president of the NEDA board of directors, notes that his clinical staff spends roughly 40 percent of their time dealing with insurance issues. “These disorders are so complex, so multidimensional, they don’t lend themselves nicely to managed care,” he says.

Not only does treatment often last for years, it requires large teams of professionals. Day treatment runs about $500 per day. If patients are without insurance or their benefits are exhausted, Bunnell says, “we try to cobble together a treatment team” through sliding scale services, often in university settings, and support groups.

Some people,” he adds, “get better with that.”

Return to: Eating Disorders: A Hidden Epidemic

Karen Reed-Matthee is a freelance writer and a former editor for United Parenting Publications.

February 2004