Two proposed class-action lawsuits are bolstering efforts to get a
tougher mental health insurance parity law in New Jersey. They are also
reinforcing a top APA priority—extending mental health parity.
Thirty-nine states have laws to assure that individuals receive the same
health insurance coverage for mental illness as they do for physical ones.
However, the scope of these parity laws and the true protection they provide
The law in New Jersey, for example, states that all mental illnesses that
are biologically based must be reimbursed comparable to other kinds of medical
illnesses. Yet when the daughter of Bart and Dawn Beye of Wayne, N.J.,
required extensive inpatient treatment for anorexia nervosa, the Beyes' health
insurance company, Horizon Blue Cross/Blue Shield of New Jersey, refused to
reimburse the Beyes for much of it, according to a report in the July 28,
2006, Newark Star-Ledger. Horizon's rationale in refusing was that
anorexia nervosa is not biologically based.
Dawn Beye “then played the insurance game [the insurance company's]
way,” she explained in a December 10, 2006, memo sent to Robert
Bransfield, M.D., a Red Bank, N.J., psychiatrist and member of APA's Task
Force on Parity, and to Psychiatric News. She said she obtained“
documented proof, letters from the top eating-disorder experts in the
United States that verify that eating disorders are biologically based.”
She filed all the appeals and even fought for an appeal through the New Jersey
Department of Banking and Insurance. “I was still denied the coverage
that my daughter is entitled to,” she said.
By going public with her battle with the insurer, Beye said, 40 other
families contacted her looking for help on how to get insurance coverage from
Horizon for their anorexic children. Thus, on November 8, 2006, she filed a
proposed class-action lawsuit against Horizon, representing all such families
in New Jersey.
Also on that day, according to the November 8, 2006, New York
Times, Cliff and Maria DeAnna of Mountainside, N.J., filed a suit against
Aetna Inc. They claimed that Aetna refused to pay for the full costs of
treating their daughter's anorexia because it was not biologically based. They
also sought class-action status for their legal claim because they contended
that many other families had been denied coverage by Aetna for the same
Indeed, according to an article in the November 10, 2006, New Jersey
Law Journal, as many as several thousand New Jersey residents who have
been refused reimbursement by Horizon, Aetna, and other insurers for anorexia
treatment are eligible to participate in such class-action lawsuits.
The argument that Horizon and Aetna are using in denying anorexia coverage,
Bransfield told Psychiatric News, is that the New Jersey parity law
gives examples of only six mental illnesses that are biologically based, and
anorexia is not one of them. Yet there is strong evidence that anorexia is
biologically based, he stressed. So, “according to the current statute,
anorexia should be included,” he said.
Although the outcome of the proposed class-action status for the suits is
not yet known, they could be a major boost for the cause of mental health
insurance parity, Bransfield believes. “We could set a precedent with
these cases, demonstrating that all DSM diagnostic categories are
biologically based,” he said.
Even if such a positive outcome does not come to pass, he added, the
lawsuits are bolstering efforts to pass a tougher mental health insurance
parity law in New Jersey.
In fact, a stronger law, which would require equal health insurance
coverage for all DSM diagnoses as well as for alcohol and substance
abuse disorders, was considered by the New Jersey Senate on December 4, 2006.
After a day of lobbying by patients' rights groups and representatives of
organized medicine—including Tim Martin, the lobbyist for the New Jersey
Psychiatric Association—on one side, and insurance companies and
businesses on the other, the Senate overwhelmingly voted for the bill.
An identical bill passed the New Jersey Assembly Health Committee and is
currently pending before the Appropriations Committee, which will have to pass
the bill before the full Assembly votes on it, Martin said. ▪