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Albany’s governor proposed budget eliminates funding for eating disorders in order to keep the focus on obesity and diseases related to obesity.

“In comparison to obesity and diabetes, eating disorders affect relatively few New Yorkers,” said Claudia Hutton, spokeswoman for the state Department of Health.

The governor’s budget will end the $1.7 million annual subsidies to the state’s three eating disorder centers, including $500,000 to Albany Medical Center. The cut would eliminate Albany Med’s entire budget and close the eating disorder program.

“It creates a huge void in the services we’ve been able to develop,” said Dr. Sharon Alger-Mayer, medical director of the Northeast Comprehensive Care Center for Eating Disorders at Albany Med.

The program serves about 2,000 people through outpatient services and 50 people who need to be hospitalized each year at Albany Med for dehydration, malnutrition and organ problems related to eating disorders.

Christie Macfarlane was hospitalized at Albany Med when she was 10 years old. She was transferred to Rochester for more intensive residential services and then returned to Albany where she has received therapy, nutritional advice and medical treatment for five years.

“I don’t know if I would be standing here right now with my 15-year-old daughter thriving if those services hadn’t been there,” said Christie’s mother, Deborah Macfarlane. The Macfarlanes and other families lobbied legislators this week to restore the funding.

“This money is critical,” said Michael Ruslander of Delmar, the father of a teenager who was in dire health because of anorexia. “The treatment my daughter received, as well as the education my wife and I received on how to deal with, communicate and eat with your child who has an eating disorder was invaluable,” Ruslander said. “It’s horrible that you have to go through something like this, but the end result is we came out a better, stronger, more communicative family.” His daughter Molly is now a healthy, successful student at Maria College.

As the state seeks to close a $6.8 billion budget gap, agencies like the DOH are focusing on core issues.

The Department of Health’s mission is safe drinking water, obesity education, childhood vaccinations, investigating disease outbreaks and hospital complaints, Hutton said.

“Those are the kind of things that are the core of public health,” she said. “They are based on what affects most New Yorkers and things that people, frankly, expect somebody to do.”

Looking at the disease statistics, eating disorders trail far behind obesity. Among New Yorkers, 25 percent are obese, nearly 8 percent have diabetes and less than 1 percent suffer from anorexia nervosa.

The eating disorder programs should see *more support from private insurance companies since the state passed “mental health parity” legislation, which requires insurers to pay for mental health services, Hutton said.

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* Yea, right! Who’s dreaming now?

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Umbrella Erin Hael

Anyone involved with eating disorders knows all too well the commitment, expense, and time that treatment and recovery encompass. There are no quick fixes on this journey towards reclaiming ones’ Life back from a devastating illness that can lead to chronic health debility and even death if left untreated.

Just mention the word “insurance” to anyone acquainted with eating disorders and you will undoubtedly get a credible grunt of frustration or despair when it comes to what insurance companies “allow” for treatment and follow up care. And for those of us who have loved ones requiring the most intense level of care in either residential ED programs and/or partial-day programs for any length of time, insurance becomes yet another demon to lock horns with; and certainly not what caregivers, families and sufferers need tacked onto an already onerous battle to save someones Life.

We have had many a battle with insurance to get our daughter the care she deserves, and to push beyond the bullying that desperate parents face when told your child cannot get the medical services s/he needs until you’ve taken out a second mortgage, gone bankrupt, taken out exorbitant loans because extended coverage was denied, but by all Dr recommendations is absolutely necessary in continuing care and treatment.

The manner at which eating disorders are covered by insurance (and obtaining equal access to quality care is another needle-in-the-haystack!) is still quite crude that my blood boils when listening to parent after parent exhaustively stating the same heartrending scenario over and over. And speaking with parents and sufferers outside the US, you find some of the same- sometimes even worse.

Well, after stating all this rather negative reality, there is some hopeful news to share with the now infamous New Jersey Blue Cross/Blue Shield class action federal court case which restores my belief, coupled with the progression of Mental Health Parity, that 2009 will continue to move forward and keep chipping away towards change in improved coverage and treatment of eating disorders that is well overdue:

 
January 10, 2009 Horizon Blue Cross/Blue Shield of New Jersey has tentatively settled a class action pending in federal court in Newark, New Jersey involving reimbursements for medical expenses relating to the treatment of eating disorders. The terms of the settlement must still be approved by the court.

Although Horizon covered treatments related to eating disorders (primarily anorexia and bulimia), including hospitalization, outpatient treatment, psychotherapy and nutritional counseling, there were benefit limits on such treatments.

Under the settlement terms, Horizon has agreed to pay claims for eating disorders that were denied because they exceeded the plans’ maximum benefit for non-biologically based mental illness.
Horizon has also agreed to give parity treatment to eating disorder claims for Horizon insureds in the future and to enhance its appeals procedure by providing the right to select review by an eating disorder specialist of all claims denied on the basis of medical necessity.

 

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:

                           __________________________________________________

– 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

 

As many of us already know recovering from an eating disorder takes time, patience, perseverance and an added sense of humor never hurts either. This journey of Hope, Change and Healing can be a long road, but well worth every step! And when a sufferer is not able to obtain the adequate and experienced care that is required for ED treatment this journey can seem like climbing the Himalayas.

Families and sufferers can have a voice and advocate for the care and support they deserve, but it takes some persistence and not taking “no” for an answer but digging deeper and rooting out the resources and connections one needs to help along this road.

One courageous and honorable teen diagnosed with anorexia has taken such a step in Northern Ireland, and is demanding change all the way to the courts to get the care she needs- bravo!

With fire-in-the-heart like that, the sky is the limit to what can be possible so that everyone suffering from this illness will eventually have access and covered care that they need to fight the battle and win their full and healthy lives back.

-shanti

President Signs Mental Health Parity Legislation!

Thanks to the thousands of Advocacy Network members who lent tireless support to our years-long effort to win enactment of legislation to end discrimination in mental health coverage. Today we won! After House passage of the Emergency Economic Stabilization Act today, 263-171, President Bush has at last signed mental health/addiction parity into law.
Click here to learn more about the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

-Fantastic news worth celebrating!

 

             Interesting use of metaphor…

                       are you taking care of your Earth Suit— I hope so!

            – Bonne Nuit

End Health Discrimination
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