Similar to the settlement last year in a case against Aetna Health, Horizon Blue Cross has reached a settlement in the case of Drazin v. Horizon Blue Cross whereby the insurance company will pay $1.2 million to the 566 affected insureds who were denied extended coverage for treatment of their eating disorders. Also part of the settlement, Horizon Blue Cross agreed to treat any future eating disorder claims by its insureds as they would claims for biologically-based mental illnesses (BBMI) like schizophrenia. Such reforms will cost the company an estimated $17.8 million.
Specifically, the extended coverage requires Horizon to abandon restrictions limiting treatments to 20 outpatient visits per calendar year and 30 days of hospitalization. As many of the patients are young women, medical experts have been saying for years that the long-term treatment is necessary to address the physical and psychological causes of the illness.
The only exception in the extended coverage applies to about 1.8 million of Horizon’s insured who fall into the category of self-funded plans, such as employee welfare and state worker health benefits programs. Such insureds do not automatically benefit from the settlement.
At Pogust Braslow & Millrood, we recognize how unjust these types of situations are, and we fight the medical insurance companies to insure that our clients receive all of the treatment they are entitled to, so that they can remain healthy or recover from their illnesses and live many years. If you have been denied coverage for treatment of your illness, please contact us for a free consultation.