HMO Sued For Inadequate Coverage of Anorexia Treatment

By EinsteinCMS Administrator

Published on November 09, 2006

The couple, Cliff and Maria DeAnna, say that Aetna decided their daughter’s anorexia was not a biologically based illness and therefore refused to pay for her inpatient treatment, which totaled almost 10 weeks.

The DeAnnas declined to give their daughter’s name, but told the New York Times that she has been hospitalized for 101 days so far this year. Aetna would only pay for 35 inpatient days. Maria DeAnna told reporters that she and her husband have used a home equity loan to pay their daughter's medical bills, which she estimated to be almost $100,000 so far.

The DeAnnas' daughter is 20 years old, 5 foot 6 inches, and weighed a scant 102 pounds when she last went to the hospital.

In 1989, a similar suit was brought against Blue Cross and Blue Shield of Greater New York. A judge ruled that anorexia, because it results in starvation — a physical state — should be covered by medical benefits.

Lawmakers and insurance companies have struggled to define anorexia, and doctors have questioned the utility of the term “biologically based.” Experts say that anorexia can be safely classified as a disease stemming from a brain disorder. The chief executive of the National Eating Disorders Association, Lynn Grefe, said that anorexia has a high mortality rate.

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