With the passing of Mental Health Parity many who suffer from eating disorders will finally (albeit slowly-see how your state ranks) be able to begin receiving adequate insurance coverage and necessary treatment needed for long term recovery goals. Great progress without a doubt.

But there is a Judge by the honorable name Faith Hochberg who is rockin‘ the houses of Aetna, Horizon- Blue Cross/Blue Shield who has recently ruled:

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– approval Tuesday to a class action settlement that requires Aetna Insurance Co. to provide about $300,000 in back payments to 119 insureds whose benefits for eating disorders were limited.

The company also promised to treat future claims more liberally and make internal reforms to resolve disputes over benefits for eating disorders.

U.S. District Judge Faith Hochberg also approved a $350,000 payment to the plaintiffs’ class counsel,
Nagel Rice in Roseland, N.J. All of the fee comes from Aetna, not out of a percentage of the class members’ recovery.

“It makes perfect sense to me,” Hochberg said after ruling that
the settlement in De Vito v. Aetna, 07-418, was fair, reasonable and adequate.

The settlement requires the company to treat some claims for anorexia and bulimia as it does claims for biologically based mental illnesses, such as schizophrenia. That makes a class of eating-disorder patients eligible for eight months of treatment, compared with 20 outpatient visits per calendar year and 30 days of inpatient benefits.

The 119 insureds who will receive checks were those who had at least one claim limited by Aetna’s practices during the past seven years. And in the future, Aetna will treat anorexia and bulimia the same way it does BBMIs.

In addition, anyone Aetna determines to have no medical necessity for enhanced eating-disorder treatment during the next four years would have the right to elect binding review by an independent eating-disorder specialist selected with input from the plaintiffs’ lawyers.

At the same time, though, the settlement affects only patients in “fully insured” plans — those funded by employers. Enrollees in self-funded plans, such as employee welfare and state worker health benefits programs, are not covered by the settlement and would not automatically benefit from the more liberal process.

Nagel estimates that about 530,000 of Aetna’s 1.2 million insureds are eligible for the new claims procedures and that the process could be worth up to $2 million in recoveries by the insureds.

Law.com

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