Judge gives go-ahead to suit charging Aetna should pay eating-disorder claims.A class-action lawsuit over Aetna Inc.'s denial of coverage for people with eating disorders eating disorders, in psychology, disorders in eating patterns that comprise four categories: anorexia nervosa, bulimia, rumination disorder, and pica. Anorexia nervosa is characterized by self-starvation to avoid obesity. may proceed under the federal Employee Retirement Income Security Act The Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.A. § 1001 et seq. (1974), is a federal law that sets minimum standards for most voluntarily established Pension and health plans in private industry to provide protection for individuals enrolled in these plans. of 1974, a federal judge has ruled. U.S. District Judge Faith S. Hochberg in Newark, N.J., denied a motion to dismiss by Aetna, which argued the coverage dispute should be handled by the New Jersey Department of Banking & Insurance or its own internal appeals procedures. Bruce Nagel, an attorney representing the plaintiffs, said the ruling is "significant because it is the first time in the country that a federal court has ruled that there was a bona fide [Latin, In good faith.] Honest; genuine; actual; authentic; acting without the intention of defrauding. A bona fide purchaser is one who purchases property for a valuable consideration that is inducement for entering into a contract and without suspicion of being claim and that the insurance company's internal appeals procedure does not trump the claim." Nagel said he will try the case to ensure coverage for hundreds of families with children suffering from eating disorders, such as anorexia anorexia /an·orex·ia/ (-rek´se-ah) lack or loss of appetite for food. anorexia nervo´sa and bulimia bulimia: see eating disorders. . Hochberg, however, dismissed the plaintiffs' claim trader the New Jersey Mental Health Parity Law and their claims for punitive damages Monetary compensation awarded to an injured party that goes beyond that which is necessary to compensate the individual for losses and that is intended to punish the wrongdoer. , saying they were pre-empted by ERISA See Employee Retirement Income Security Act. ERISA See Employee Retirement Income Security Act (ERISA). . The suit claims Aetna allegedly denied the claims for treatment as "not medically necessary medically necessary Managed care adjective Referring to a covered service or treatment that is absolutely necessary to protect and enhance the health status of a Pt, and could adversely affect the Pt's condition if omitted, in accordance with accepted " by wrongly classifying eating disorders as nonbiologically-based mental illness. The court said Aetna's policy definition of "biologically-based mental illness" substantially follows the definitions found in New Jersey's parity law, but that it doesn't define non-BBMI. Aetna argued that a law extending parity law coverage to eating disorders already passed the New Jersey Senate and is pending before the state assembly. But Hochberg noted that Aetna's policies were "silent on whether plaintiffs' eating disorders are or are not BBMIs."
No Appetite
Eating disorders often start
in elementary school and
continue into adulthood.
[ILLUSTRATION OMITTED]
%
1st-3rd grade girls who want to be thinner 42
10-year-olds who fear being fat 81
9- and 10-year-old girls who feel better on a diet 51
9- to 11-year-olds who diet sometimes or very often 46
Women who are heavier than most fashion models 98
Normal dieters who become pathological dieters 35
American men on a diet, any given day 25
American women on a diet, any given day 45
Dieters who regain lost weight within five years 95
Source: National Institute of Mental Health
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