Eating Disorders - fieldi

Eating Disorders and Managed Care 109
Eating disorders have been particularly affected by managed
behavioral health care because of the frequent need for extended
treatment and because of efforts to trivialize or blame the individual
for her disorder. Seriously ill patients suffering from the ravages of
eating disorders are considered self-destructive and not worth the
expense of adequate hospitalization. Arnold Andersen (1998) notes
that along with some positive trends, there “have been predatory,
irresponsible changes based on the assumption that health care is
simply a business commodity.” The splitting of the medical and psychiatric
components of eating disorders and the underfunding of the
latter has deprived patients of vital care. Legislation to provide parity
in coverage for psychiatric and medical disorders was passed by
Congress in 1996 but has been restricted to certain illnesses, and
these do not include eating disorders.
Federal legislation, namely, the ERISA (Employment Retirement
Income Security Act), was enacted in 1974 in response to concern
that corrupt, incompetent pension managers were mismanaging the
self-funded employee benefit plans entrusted to them,, including
retirement and health insurance. When passed, ERISA had no connection
to malpractice liability. Whereas clinicians can be sued for
compensatory damages in malpractice suits, the law has shielded
HMOs who can only be sued for medical costs amounting to far less
than could be recovered under punitive damages. The New York
Times (Pear 1998) reported that both judges and legislators have
become concerned about the failures of ERISA to protect consumers
and sufficiently punish organizations that are found negligent
in denying care. For instance, because of ERISA, one federal
court noted that, in the event of a suicide following a denial of psychiatric
care, family members could not sue the HMO or insurance
company for wrongful death.
In order to justify payment for treatment of psychiatric disorders,
managed care companies demand considerable information about
the nature and severity of the disorders as well as the degree to
which the patient’s functioning is impaired. Patients and their
treaters are assured that such information shall be privileged and
confidential. In practice, however, according to many reports, widespread
and flagrant violations of confidentiality take place. Frequently
employers receive reports from insurance companies and