Because we all know who the victims are here: the companies.

Since I can't really bring myself to total up the amount of money I've cost my parents and myself trying to "just get over it already," I viewed this article with a mix of hope and resignation. Relatively speaking, my ED tag isn't even that pricey (no long or repeated in-patient stays). Over the course of 6+ years, though, it's hard to think about where all that money coulda woulda shoulda gone.

To summarize, some parents are suing BlueCross BlueShield of New Jersey (hey! that might be relevant to me in 2 years! I'd better read this!) for coverage of their daughters' eating disorders as biologically based illnesses. However,

"In a ruling released last week, [Judge] Hochberg refused to dismiss the case or abstain from decision[.]"

Yay! Oh, wait:

"[B]ut she threw out a significant chunk of the litigation."

Hm. Which part, I wonder?

"The result was to knock out those plaintiffs' claims under the Mental Health Parity Law and the Consumer Fraud Act, along with common-law claims for breach of contract, breach of implied duty of good faith and fair dealing, misrepresentation, unjust enrichment and tortious interference with contract. They are left only with their claims under ERISA, which does not afford a jury trial and often requires review under an arbitrary and capricious standard.

"On the other hand, the plaintiffs insured under policies not subject to ERISA can go forward with most of their claims. It is not clear, however, whether they can assert a claim under the Mental Health Parity Law. Hochberg left undecided the novel question of whether there exists an implied private right of action under the 1999 law."

BC/BS (and other insurance co.'s, historically, won't pay, which means (intuitively, but maybe not in legalese) that BC/BS thinks that eating disorders aren't "real" diseases. Thanks, Insurance Industry. You've got your priorities really straight. Next you'll have Bill O'Reilly in court for you, testifying how he doesn't want his premiums to go up because of some rich, white teenager's "choice." Speaking from a standpoint of total ignorance about the actual legal angle of this, I'd just like to say that an insurance policy not covering mental health benefits, including eating disorder treatment, has always seemed like "breach of implied duty of good faith and fair dealing" to me. And speaking from that same perspective, "arbitrary and capricious standard" doesn't sound... um... hopeful. Yeah. But if you ask me, however, what the above paragraphs *actually* mean, I will stare at you with a glassy look in my eyes, while secretly thinking about Alexander Skarsgard.

Mmmmmmm. Sweeeedes. Mmmmmm.

And one last thing, about one of the statements made by a lawyer for the "defendant" [i.e., bloated corporate machine]: "He emphasizes that the company did not deny coverage and that the plaintiffs seek unlimited coverage, beyond what the policy provides."

Dear Mister Lawyer Person: I may deal with a different state plan of BC/BS, but under my plan - all my plans ever with BC/BS - I have never been given ANY coverage for eating disorder-related costs. My doctors have had to jump through hoops so EKGs would be covered, of all things. We won't even get started on the lack of therapy reimbursement or the laughable response my parents got when submitting for outpatient benefits a few years ago. However, HAD you paid, you might have avoided, by this point, quite a bit of pharmaceutical costs from THIS particular account number, which I'm sure have run way up for you, being that I've never been prescribed a generic. You know. For my "depression." Not to the "eating disorder." For the "depression." For which you "offer [a pittance of] coverage." Ha. Ha ha ha. That's all I have to say about that.

For some general context, here's a good two-liner:

"Pending legislation, S-607/A-2077, would eliminate disparate treatment for nonbiologically based mental illness. A similar bill in the last legislative session passed the Senate and two Assembly committees but was never brought to a vote in the Assembly."

"Never brought to a vote" sums it up nicely, I think.

This also sums it up nicely:


1 comment:

  1. Since when can judges "throw out" bits of litigation? is that like kids picking the peas and onions out of soup?! ree-dic-u-lous.


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