National Eating Disorders Association

Victory for Care and Coverage for Eating Disorders!

Caitlin Hamilton, Communications Associate

In 2010, the family of a 14-year-old girl who was suffering from anorexia filed a complaint against health insurance giant Cigna for denying coverage for the nutritional counseling her doctors deemed necessary. This complaint, and many others like it, prompted the New York Attorney General’s office to launch an investigation into some of Cigna’s practices. The investigation uncovered the wrongful denial of claims for nutritional counseling for mental health conditions (largely eating disorders), and last month, years after the first complaint was filed, Cigna reached a settlement with the New York Attorney General’s office

The details of the case are complex, but the underlying principle is simple. Cigna was not complying with New York’s “mental health parity laws,” which require health insurance companies to cover the treatment of mental disorders as equally as they would other health conditions. In this case, for example, Cigna was capping the number of nutritionist visits for someone suffering from an eating disorder at three, but they were not making similar caps for people who were suffering from diabetes or other such conditions.

In other words, despite the fact that the visits to the nutritionist were determined medically necessary for those struggling with an eating disorder, their claims were treated differently simply because they are categorized as mental disorders. This bias, according to New York’s Timothy’s Law, is illegal.

Timothy’s Law mandates that New York group health plans provide “broad-based coverage for the diagnosis and treatment of mental, nervous or emotional disorders or ailments … at least equal to the coverage provided for other health conditions.” This important law was enacted in 2006 after Timothy, a 13-year-old boy from Schenectady, committed suicide when an insurance company denied ongoing coverage for treatment of his serious mental health issues, including hospitalizations. When outlining the mental health parity law, eating disorders are specifically defined as deserving equal coverage.

This settlement with Cigna is a big victory in the fight for appropriate care and coverage for eating disorders. It is a clear message to all New York health insurance providers that Timothy’s Law will be enforced.

“State law clearly requires health insurance companies to provide mental health benefits on par with other medical benefits. There is no gray area here,” said Attorney General Schneiderman. “… [the]settlement puts insurance companies on notice: My office will aggressively enforce mental health parity laws and fight to give patients the benefits they are legally entitled to – and which they pay for.”

According to a statement released by the Attorney General’s office, Cigna has agreed to eliminate the three-visit cap for mental health conditions and to reprocess and pay members whose claims were denied due to the limit, totaling approximately $33,000.

If you are a New York State resident and have a complaint regarding health insurance coverage for mental health, you may contact the Attorney General’s Office Health Care Helpline at 800-428-9071.