Eating Disorder Coverage Agreement Gets Court OK

The New Jersey Law Journal reported that   U.S. District Judge Faith Hochberg of the U.S. District Court for the District of New Jersey handed down the decision after a plaintiffs’ lawyer told her the deal was good for his clients and avoided additional potential risk if the matter had gone to trial. Earlier this month the insurer agreed to pay $250,000 to be allocated to as many as 100 policyholders in the state for claims for treatment of anorexia and bulimia (See Aetna Agrees to $250,000 Settlement of Eating Disorder Coverage Claim ).

Hochberg will decide whether to grant permanent approval after all plaintiffs are notified and have time to file objections with the court.

Under the pact, Aetna will treat some claims for anorexia and bulimia as it does claims for biologically based mental illnesses (BBMI), such as schizophrenia, the report said. BBMI claimants are eligible for months of treatment, while those with non-BBMIs are limited by Aetna to 20 outpatient visits per calendar year and 30 days for inpatient benefits.

Aetna agreed to establish a process in which eating-disorder patients for whom coverage is denied can appeal to an internal panel. The company also will pay up to $350,000 in plaintiffs’ legal fees.