A previous article on this topic page reported that insurers frequently refuse to cover long hospital stays anorexics often require. But because of recent state and federal legislative action, that situation is changing.
According to an article published on insure.com, the Mental Health Parity Act of 1996 was intended to put coverage for mental illnesses, including eating disorders, on an equal footing with that of physical ailments. However, the Act, which went into effect in January 1998, contained loopholes. The most important of these, according to the article, is the provision prohibiting insurers from setting spending caps for mental health costs. Employers are able to circumvent this restriction by limiting the number of covered visits patients can have with therapists, or the number of covered days for inpatient or outpatient treatment.
U.S. Senators Pete Domenici (R-New Mexico) and Paul Wellstone (D-Minnesota) have sought to remedy this situation by introducing a Congressional bill that would provide full insurance "parity" between treatment for mental and physical illnesses. According to a February 25, 1999 press release by the National Alliance for the Mentally Ill (NAMI), the bill would guarantee equitable coverage for disorders such as severe anorexia by eliminating "unequal restrictions on annual and lifetime mental health benefits, inpatient hospital days, outpatient visits, and out-of-pocket expenses."
NAMI notes that the legislation would only apply to employers with group plans that already cover emotional disorders. In addition, small businesses with 25 or fewer employees would be exempt.
A 1999 Clinical Psychiatry News article reprinted on Medscape observed that the House version of the bill, introduced by Representative Marge Roukema (R-New Jersey), would provide broader coverage--including provisions that would equalize inpatient and outpatient visit limits, copays, and deductibles for mental health and purely physical conditions. However, the more modest Senate version, according to the article, is designed to minimize opposition from business and insurance interests.
Opponents of the legislation say that it will greatly increase premiums. According to CPN, the 1996 Act exempts plans in which compliance would increase costs by more than one percent, but neither version of the proposed legislation contains this exception. Mental health advocates, according to CPN, argue that any added costs would be offset by increased worker productivity. This position appears to be bolstered by a caringonline article which notes that the portion of medical premiums attributable to mental health benefits actually decreased by 0.2 percent in Maryland after that state's implementation of a parity statute.
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