Blue Shield Must Provide Residential Care Benefits: Mental Health Parity Mandates Coverage for Underlying Depression and Panic Disorders

LOS ANGELES, JANUARY 18, 2012 – Kantor & Kantor, LLP announced today that the U.S. District Court for the Central District of California ruled in favor of the firm’s client Laura Burton, deciding that California’s Mental Health Parity Act mandates that Blue Shield of California must provide benefits for residential treatment of Ms. Burton’s major depressive disorder and panic disorder.

“Mental health parity is firmly established law in California,” said Lisa Kantor, who represents Ms. Burton. “Blue Shield continues to act as if the Act doesn’t exist by denying residential treatment when it is clearly medically necessary. That attitude is offensive to both policyholders and the legal system.”

In Burton v. Blue Shield of California, the court held that under the Act, Blue Shield must cover “medically necessary treatment of severe mental illnesses” under “the same terms and conditions applied to other medical conditions. … The Ninth Circuit interpreted the Act to require that insurance companies provide coverage under the same financial terms and conditions for medically necessary treatment of ‘severe mental illnesses’ and medical conditions.”

The Ninth Circuit case the district court referred to is Harlick v. Blue Shield of California, an August 2011 ruling that determined California’s Mental Health Parity Act requires insurers to pay for eating disorder treatment at residential facilities. That case, in which Ms. Kantor represented a plaintiff denied residential treatment benefits for anorexia, was the first decision to determine that the phrase “same terms and conditions” included financial terms. The court cited in that ruling the nine mental illnesses enumerated in the Act: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depression, Obsessive-Compulsive Disorder, Panic Disorder, Eating Disorder (Anorexia Nervosa and Bulimia Nervosa), Autism or Pervasive Developmental Disorder, and Serious Emotional Disturbance in children and adolescents.

The Burton court, dealing with major depression and panic disorders, relied on that language, pointing out the impossibility of separating treatment for severe underlying mental illnesses from treatment for alcohol dependency.

For more information about Lisa Kantor and legal assistance for residential treatment for mental illness, log on to http://www.kantorlaw.net/Areas_of_Practice/Eating_Disorders.

Contact: Laura Discipio or Chevese Turner                                    FOR IMMEDIATE RELEASE

Telephone: 630-577-1330 or 855-855-BEDA

Email: laura.discipio@anad.org or chevese.turner@bedaonline.org

LEADING EATING DISORDERS ORGANIZATIONS AGREE THAT CHILDREN’S HEALTHCARE OF ATLANTA AD-CAMPAIGN IS SHAMING AND DANGEROUS

Chicago, IL – January 12: The National Association of Anorexia Nervosa and Associated Disorders (ANAD) and the Binge Eating Disorder Association (BEDA) appeal to the Children’s Healthcare of Atlanta (CHOA) to discontinue their fear and shame-based advertisements objectifying children. Campaigns that focus on overall wellness, not weight shaming, should be the goal.

The CHOA released a new ad-campaign, known as Stop Sugarcoating, utilizing negative attention and shaming to address childhood obesity. Recently, concern has risen in the state of Georgia, which is ranked the second highest prevalence of childhood obesity in the country, prompting the development of the campaign.

Chevese Turner, Executive Director of BEDA, states, “This ad campaign has the potential to inflict harm through the message it sends. The creators of the campaign quite obviously do not understand the psychological impact this has for individuals of size, including children. CHOA clearly believes this approach will work, despite a growing number of professionals and experts in both the obesity and eating disorders field who disagree because of the growing evidence that shaming and stigmatizing actually lead to weight gain over time. We have received close to 1,000 signatures, within a week’s time, on our petition to end this campaign; the public and many professional physical and mental health providers have joined us to let CHOA know that this approach is dangerous and should be discontinued immediately.”

Laura Discipio, Executive Director of ANAD, says, “Research has shown that children as young as five years old already have been conditioned to fear being fat.  CHOA continues to perpetuate this fear by using shaming and bullying tactics targeted at children who are of larger size. But unfortunately, children who are of normal or low weight can also be negatively affected. This Ad-campaign has the potential of doing more harm than good. Shaming our children should not be tolerated!   Feeling good about yourself increases the likelihood that you will take good care of your body and decreases the likelihood of disordered eating. Instead of shaming our children, let’s help them feel good about themselves and provide all children an opportunity to engage in healthy lifestyles so they can develop healthy attitudes and behaviors and healthy bodies.”

Discipio adds, “Chevese and I, as well as our expert boards and scientific committees, welcome an open conversation with the developers of this ad campaign and future weight-related campaigns to discuss effective and healthy ways to address these important issues. We must be cognizant of the fact that many of the obesity efforts underway in this country are worrisome-at-best and can lead to eating disorders, which have the highest mortality rate of any psychiatric illness and have realized a significant rise in prevalence over recent years.”

To view the Stop Sugarcoating campaign: www.strong4life.com

The National Association of Anorexia Nervosa and Associated Disorders, Inc. (ANAD) is a non-profit (501 c 3) corporation that seeks to prevent and alleviate the problems of eating disorders, especially including anorexia nervosa, bulimia nervosa and binge eating disorder. ANAD advocates for the development of healthy attitudes, bodies, and behaviors. ANAD promotes eating disorder awareness, prevention and recovery through supporting, educating, and connecting individuals, families and professionals.

The Binge Eating Disorder Association (BEDA) was founded to help those who have binge eating disorder, their friends and family, and those who treat the disorder. BEDA provides individuals who suffer from binge eating disorder with the recognition and resources they deserve to begin a safe journey toward a healthy recovery. BEDA also serves as a resource for treatment providers to prevent, detect, diagnose, and treat the disorder. By establishing strong connections among members and sister organizations, BEDA’s goal is to give everyone access to the tools they need to live with, treat, and, ultimately, prevent the disorder.

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For more information regarding ANAD, visit www.anad.org

To connect with help, call 630-577-1330 or email anadhelp@anad.org

For more information regarding BEDA, visit www.bedaonline.org

To connect with help regarding binge eating, call 855-855-BEDA

Available for Interviews:

Laura Discipio, Executive Director of ANAD

Chevese Turner, Executive Director of BEDA

Treatment specialists for the spectrum of all eating disorders

Recent multiple brain imaging studies of patients with restricting-type anorexia nervosa (AN) reveal neurocircuit dysregulation and may help clarify the disorder’s confounding symptoms.

In a review article, Walter Kaye, MD, director of the Eating Disorders Program at the University of California, San Diego (UCSD), and his coauthors¹ said that insights into the ventral (limbic) and dorsal (cognitive) neural circuit dysfunction, perhaps related to altered serotonin and dopamine(Drug information on dopamine) (DA) metabolism, may help explain why individuals with anorexia often report that dieting reduces their anxiety while eating increases it and why they worry about long-term consequences but seem impervious to immediate gratification and unable to live in the moment.

Many women diet in this culture, but relatively few (0.5%) have anorexia, Kaye told Psychiatric Times. “Why is that? Well, you pretty much have to have a certain temperament and personality in childhood to be vulnerable for . . . an eating disorder,” said Kaye. “Not everyone who develops anorexia has all these traits in childhood, but most have one or more of them,” he said. “These traits include harm avoidance, anxiety, behavioral inhibition, difficulty with set shifting [easily moving from one mental set to another], a tendency to focus on details rather than the big picture, and perfectionism.” Even after recovery, these personality and temperament traits persist, pointing to underlying neurobiological factors.

Another clue is the relatively stereotypic course of anorexia. That is, anorexia tends to occur in females with onset during adolescence when some combination of puberty, brain development, stress and/or sociocultural factors comes into play, provoking the onset of anorexic symptoms. Anorexia is marked by body image distortions and the fear of being fat and results in a downward spiral of weight loss that is difficult to reverse.

Once an individual becomes anorexic, starvation and malnutrition affect every system of the body, including the brain. Such changes include neurochemical imbalances, which may, in turn, exaggerate the preexisting traits and accelerate the disease process. Individuals with anorexia, for example, have a reduced brain volume and a regression to prepubertal gonadal function, Kaye said. Yet, these disturbances tend to normalize after weight restoration, which suggests that they are state-related alterations.

In their article, Kaye and colleagues distinguish between state-related and trait-related abnormalities, and then review how new brain imaging technologies are helping identify the brain pathways involved in AN.

Brain imaging

Studies using positron emission tomography (PET) brain imaging and related technologies have assessed serotonin and DA neurotransmitter systems in individuals with anorexia and in those who have recovered, while studies using functional MRI (fMRI) have illuminated altered activity in interconnected brain regions of these individuals.

Imaging studies suggest that individuals with anorexia have an imbalance between circuits in the brain that regulate reward and emotion (ventral) and circuits that are associated with consequences and planning ahead (dorsal).² Brain-imaging studies also show that individuals with anorexia have alterations in those parts of the brain (eg, anterior insula) involved with interoceptive self-awareness that may be implicated in disturbed bodily sensations.³ In addition, altered function of other related regions may contribute to altered sensing of the rewarding aspects of pleasurable foods. Individuals with anorexia may literally not recognize when they are hungry.

The neurotransmitters serotonin and DA are primary targets of study, according to Kaye. “Simply put, the serotonin system tends to be inhibitory while the dopamine system is associated with signals about reward.”

Kaye said that evidence from imaging studies suggests that disturbances in the serotonergic system might contribute to vulnerability for restricted eating and behavioral inhibition as well as a bias toward anxiety, particularly excessive concern with consequences. Meanwhile, DA dysfunction, particularly in striatal circuits, may contribute to altered reward, decision making, stereotypic motor movements, and decreased food ingestion.

Evidence that the dopamine system is involved includes reduced cerebrospinal fluid levels of DA metabolites both in ill individuals and in those who have recovered from anorexia, functional DA _D2 receptor gene (DRD2) polymorphisms in individuals with anorexia, and impaired visual discrimination learning. A PET study found that subjects who recovered from AN had increased D₂/D₃ receptor binding in the ventral striatum, a region that modulates responses to reward stimuli.4 This finding could indicate increased D₂/D₃ receptor densities, decreased extracellular DA, or both in individuals who recovered from anorexia.

With regard to serotonin, brain imaging studies consistently show that when compared with healthy subjects, individuals with or those who have recovered from eating disorders have an imbalance between enhanced 5-hydroxytryptamine (serotonin) receptor 1A (5-HT_1A) and diminished 5-HT_2A receptor binding potential.¹ “Eating carbohydrates is thought to increase extracellular serotonin levels, which, in turn, may drive anxiety and harm avoidance in AN. . . . Because these symptoms are correlated with 5-HT_1A receptor binding in anorexia, stimulation of 5-HT_1A receptors offers a potential explanation for feeding-related dysphoric mood in AN. When individuals with AN starve, extracellular serotonin concentrations might diminish, resulting in a brief respite from dysphoric mood.”

End of Year Package Would Cut Hospital Funding More than $17 billion

“How can someone get that skinny and not realize it?”  It’s a familiar question we receive whenever we visit schools or give presentations in the community.  Many people find it hard to understand how severely an eating disorder can distort someone’s perception (more…)

In the October Archives of Pediatrics and Adolescent Medicine,  results from a Canadian Paediatric Surveillance Program Study of approximately 2453 Canadian pediatricians (a 95% participation rate) was conducted monthly during a 2-year period. This is the first country-wide study in North America to examine the incidence of restrictive eating disorders among children. Results indicated that eating disturbances can result in serious medical consequences, ranging from growth delay to unstable vital signs.  The study found a greater percentage of 5 – 12 year olds with disordered eating than those that were diagnosed with Type II Diabetes.

For greater detail:   Abstract

Source: Archives of Pediatrics and Adolescent Medicine

The Ninth Circuit Appeals judges, based in San Francisco, ruled that residential treatment was medically necessary for eating disorders, and therefore had to be covered under the state’s parity law, even if no exact equivalent existed on the physical disease side.  Ms. Harlick’s lawyer, Lisa S. Kantor, argued that residential treatment centers were equivalent to skilled nursing facilities, which Blue Shield did cover. Some insurers say that there is no treatment for physical illnesses that is equivalent to residential treatment for mental illnesses, and therefore residential treatment does not have to be paid for under parity laws.  Ninth Circuit Court Ruling

Dr Anne E. Becker, president of the Academy of Eating Disorders and director of the eating disorders program at Massachusetts General Hospital, said that despite a paucity of studies, “There’s no question that residential treatment is life-saving for some patients.”

Source: The Wall Street Journal

According to social anthropologist Dr Megan Warin her studies of people with anorexia nervosa who delay or don’t seek treatment do so for a reason.  Many had felt disconnected from society before developing anorexia.  By controlling their eating, they end up belonging to a group of people who are essentially successful at dieting.

“Anorexia is very empowering for people in the early stages of the illness. In fact, they don’t see it as an illness, they see it as a lifestyle.” said Dr. Warin  “The people who had recovered changed their identitites and got rid of the anorexic identity and became something other” she explained.

For more information about this research: National Eating Disorder Collaboration/Sydney

Greater training on BDD is needed for plastic surgeons

A new study published in Plastic and Reconstructive Surgery revealed that over one-third of patients who get a nose-job (rhinoplasty) have symptoms of moderate or severe Body Dysmorphic Disorder (BDD).  BDD is a mental illness where someone fixates on a real or imagined imperfection to the point where it impairs their social functioning and other areas of their life.  The study was conducted on 250 Belgian patients by Researchers from the University Hospitals Leuven in Belgium.  While there are regulations that require board-certified plastic surgeons to screen their patients for illnesses like BDD, any doctor can perform cosmetic surgery, and non-board-certified physicians may not be so careful.

There is a clear need for greater regulations of physicians performing plastic surgery.  Please contact The American Society of Plastic Surgeons (http://www.plasticsurgery.org/Contact-Us.html) to ask them to increase education about and requirements for screening this dangerous disorder.

Source: Plastic and Reconstructive Surgery

Airbrushed Ads: Julia Roberts (left) and Christy Turlington (Right)

Two L’Oreal makeup advertisements featuring actor Julia Roberts and supermodel Christy Turlington have been banned in the UK.  According to the Advertising Standards Agency (ASA), a British watchdog agency, the ads had undergone significant airbrushing, to the point that, “We could not conclude that the ad image accurately illustrated what effect the product could achieve, and that the image (more…)