When her health insurance provider told Holly Naunheim that it wouldn’t cover her daughter’s stay in a residential treatment facility for an eating disorder, she was furious.
“I was hysterical,” Naunheim said. “My husband and her therapist said, ‘We’re going to fight this.’”
Naunheim's daughter, Rosie, 15, had struggled with anorexia for three years, going in and out of doctor’s offices and a treatment center. In the eighth grade, she was so sick that she had to attend her graduation with a feeding tube taped under her nose.
“It’s something that takes over not just your body but your mind,” Rosie said. “I couldn’t focus on school work because I was too busy counting calories.”
The reason the insurance company denied Rosie: her condition was not severe enough to warrant 24-hour treatment.
“We spend our whole lives working and paying into that stuff, paying the premiums,” Naunheim said. “I deserve to be able to use that money to save my daughter.”
After pleas from the family and Rosie’s doctor, the insurance company relented, and Rosie spent six months in a local treatment facility. She’s now 16, lives at home and attends regular classes at school, but says that she’s still recovering mentally.
One bill awaiting the governor’s signature at the Missouri Statehouse would add an extra layer of protection for families like the Naunheims: SB 145.
The Affordable Care Act already requires insurance companies to cover treatment for eating disorders under a mental health parity law, but some patients reported they are still denied coverage because their Body Mass Index measurements were above a predetermined level.
“It happens, unfortunately, quite often,” said Dr. Jessica Gerfen, a psychologist at the St. Louis Behavioral Medicine Institute. "Patients who are still engaging in disordered eating behaviors such as binging or purging may no longer meet the weight qualification, and have to leave treatment before they are ready," she said. Relapses can be common.
“It can certainly impede their recovery,” Gerfen said.
The Missouri law, SB 145, specifies that insurance companies cannot deny care based on a patient’s weight. Among major insurance companies doing business in Missouri, Anthem Blue Cross Blue Shield includes “the adult’s weight is less than 85% of estimated healthy weight” as one criteria for covering residential treatment of anorexia, but other criteria can also be met.
Paid out-of-pocket, treatment for an eating disorder can cost tens of thousands of dollars.
A fiscal note estimates that SB 145 will cost the state less than $12,500 a year to comply with the rule. Each year, Missouri’s Medicaid program covers about 800 people who have eating disorders.
The measure was first introduced seven years ago by former state Rep. Rick Stream, R-Kirkwood, whose daughter Katie died in 1995 after a long struggle with an eating disorder.
The new legislation would require insurance companies to make any necessary changes to health plans before coverage begins for the year 2017.
Gov. Jay Nixon has until July to sign the bill into law.