On May 13, 2015, lawmakers passed Missouri Senate Bill 145. The bill requires health benefit plans written in Missouri, as well as plans written outside of Missouri that cover Missouri residents, to cover the diagnosis and treatment of eating disorders.
Although insurance companies were already required to cover eating disorders under the mental health parity law, coverage did not apply to all aspects of the treatment. In some cases, insurance companies were not required to cover the cost of residential treatment for the entire duration of a patient’s stay in a residential treatment facility, forcing the patient to discontinue treatment prematurely or pay for the remainder of the treatment out-of-pocket. For many patients, an uncovered stay in a residential treatment facility was cost prohibitive, as the average cost of a residential program is $30,000 each month. Many of the patients who were unable to afford the high cost of out-of-pocket treatment saw their recovery impeded by an early departure from the treatment facility.
The reason why insurance coverage for residential treatment was cut off for many patients was because prior to the passage of this bill, the law did not require insurance companies to pay for treatment consistent with the medical community’s currently accepted standard of care for eating disorders. Specifically, many policies denied coverage for residential treatment to patients whose weight or Body Mass Index measurements were above a predetermined level, even if other factors indicating the need for continued treatment were still present.
The passage of Bill 145 is good news for people suffering from eating disorders and their families. Bill 145 will require insurance companies to extend coverage to “medically necessary treatment” provided by certain licensed professionals. Additionally, the bill provides that “medical necessity determinations… shall consider the overall medical and mental health needs of the individual with an eating disorder” and “shall not be based solely on weight.” This means that when a medical professional assesses all the needs of a patient and determines that a particular course of treatment is medically necessary based on the current authoritative standards of treatment in the medical community, the insurance company will be required to cover it. So even if a patient has a normal weight, the insurance company will be required to cover that patient’s continued residential treatment if a medical professional determines that it is still necessary based on other factors of the patient’s health.
Governor Jay Nixon has until July to sign off on Bill 145. Once signed, the law will take effect on January 1, 2017. Although insurance claims adjusters likely will continue to deny coverage to many patients in need of residential treatment for eating disorders, the new law will give plaintiff’s lawyers like those at Gallagher Davis a powerful tool to fight for their clients and ensure that they receive the treatment they need at an affordable price.