Insurer Sued over Eating Disorders [Podcast]
Shelby Oppel Suffers from a Severe Eating Disorder
Shelby Oppel suffers from bulimia, a psychiatric problem of excessive eating, followed by induced vomiting, or use of diuretics and laxatives. A doctor at a psychiatric hospital recommended Oppel receive 6 months inpatient treatment and 6 months outpatient treatment. Oppel’s insurer, Blue Cross Life & Health Insurance Co. (in California also called Anthem Blue Cross), would only cover six days of inpatient services and 17 days of outpatient treatment. As this proved insufficient, Oppel relapsed into her vicious cycle of binging and purging.
She sought out personal injury lawyer, Kathryn Trepinski. who filed a proposed class action in a Los Angeles court.
Eleven million Americans suffer from eating disorders, with only about 10 percent receiving treatment. “A lot of the problem is that for-profit insurance is not stepping up and is not providing the coverage needed and mandated under the statute, the California Mental Health Parity Act,” says Trepinski.
Oppel’s Class Action
Trepinksi explains a class action is meant to address harm inflicted on a large number of people, who suffer the same kind of harm across the board. In the proposed class action, Oppel would act on behalf of people damaged in a similar way by Anthem. Trepinski says the class action is a tremendous weapon for addressing an insurer’s egregious misconduct.
Oppel’s lawsuit has three causes of action.
The complaint alleges Anthem violated the California Mental Health Parity Act. This act means that people with psychiatric disorders should receive the same treatment and coverage as patients with a “medical only” condition. Insurers cannot offer less coverage to people receiving psychiatric care.
It also alleges Anthem violated the Unruh Act, which protects civil rights. Trepinski claims Anthem intentionally discriminated against people with severe mental illnesses. She says Anthem violated the policyholders’ civil rights.
Finally, the complaint alleges the insurer violated the ban against the corporate practice of medicine. “[In California], corporations cannot practice medicine nor can they interfere with or influence a physician’s independent clinical judgment. We believe Anthem’s practices here overreached and that Anthem basically began treating the patients instead of the actual treating physicians,” says Trepinski.
For people similarly situated to Oppel, Trepinski recommends they do not accept a denial at face value. She asserts some of the doctors the Anthem used to deny coverage were compromised, had serious disciplinary records and conflicts of interest. She says patients should research doctors on the medical board websites, looking for whether the doctor has been publicly reprimanded or disciplined.
She advises that patients denied insurance coverage should “push back.”