(CN) - Blue Shield of California must pay for a severely anorexic woman's nine-month stay in a residential treatment facility, the 9th Circuit ruled Friday, finding that the state's mental-health parity law required the coverage even if the woman's insurance policy did not.
Jeanene Harlick, a 37-year-old who has battled anorexia since she was a teenager, relapsed in 2006 and spent nine months in Missouri's Castlewood Treatment Center, a residential facility that specializes in eating disorders. When she checked in at her doctor's behest, she was at 65 percent of her ideal body weight and was soon being fed through a tube, according to the complaint.
Blue Shield of California, with whom Harlick had a medical insurance policy through her employer, eventually agreed to pay professional fees incurred at Castlewood, but consistently refused to pay for all but 11 days of Harlick's stay because her policy did not cover treatment at a residential facility.
Harlick sued the insurance company in 2008 in California's Northern District. Finding that Harlick's plan clearly excluded coverage for residential treatment, Senior U.S. District Judge Samuel Conti ruled for Blue Shield.
But the federal appeals court in San Francisco reversed Friday based on California's Mental Health Parity Act, which requires that carriers pay for "medically necessary treatment" of certain severe mental illnesses, one of which is anorexia.
"The most reasonable interpretation of the parity act and its implementing regulation is that plans within the scope of the act must provide coverage of all 'medically necessary treatment' for the nine enumerated 'severe mental illnesses' under the same financial terms as those applied to physical illnesses," Judge William Fletcher wrote for a unanimous appellate panel.
"Given that Harlick's doctors believed that outpatient treatment was insufficient, that Harlick entered Castlewood at 65 percent of her ideal body weight, and that Harlick needed a feeding tube while at Castlewood, it seems likely that more than outpatient treatment was indeed necessary," he added.