been to give us this “extra” coverage, which frankly will take us through another week and a half and then dump us right back on the road to financial ruin. If Kitty winds up in an inpatient residential treatment center, then we’re really screwed: one to two thousand dollars a day, of which our insurance will cover six days. Six days, out of, say, a forty-five-day admission. Thirty-nine uncovered days at the conservative estimate of $1,000 a day equals $39,000. Where would we get the money?
And we’re in good shape compared with other families. I’m probably not going to lose my job because of Kitty’s illness. If I worked elsewhere—at a law firm, say, or a 7-Eleven—I’d have been fired long ago or would have had my pay docked. We’re lucky, relatively speaking, but the situation is still unfair. Besides, these months of guerrilla warfare against an enemy I can’t see or understand have left me spoiling for a fight.
And so I make phone calls to the insurance commissioner, the president of our insurance company, our legislators, the local branch of the National Alliance for Mental Illness. I call Kitty Westin, who brought a lawsuit against her insurance company, Blue Cross Blue Shield, after her daughter, Anna, was denied treatment for an eating disorder and committed suicide. Westin settled out of court in June 2001, and part of the settlement was that BCBS in Minnesota must now cover eating disorders the way they cover broken legs and other undeniably physical ailments. After the settlement, several other big insurers in the state voluntarily changed their coverage too, afraid of similar suits they couldn’t win. Westin, who created a foundation in her daughter’s name, encourages me to push for legal action. “That’s the only way things will ever change,” she tells me.
The president of the insurance company doesn’t return my calls, surprise surprise; neither do the legislators. I tell someone at the insurance commissioner’s office about Kitty Westin, and he tells me we have no case. Minnesota has mental health parity laws; our state doesn’t. Our insurers have fulfilled their legal obligations and then some. “So that’s it?” I say. “We have no recourse? We’re supposed to go home and be grateful we’re not in debt for $100,000?” Pretty much.
The only thing left to do is file a grievance with the insurance company and ask for an appeals hearing, which they have to give us. Dr. Beth says she’ll come to the hearing if she can. But the insurance company gives me only a few days’ notice, and she can’t rearrange her schedule.
So on the appointed afternoon I drive thirty miles to the company’s brand-new world headquarters, which looks incongruous in its cornfield, on the outskirts of a small rural town. And at the appointed time I am ushered in to a conference room and seated at the head of a table full of people, none of whom introduce themselves. I’ve got ten minutes, so I talk fast. I roll out facts and statistics: average length of illness is five to seven years, average anorexia patient requires multiple hospital admissions, a third become chronic. I detail the high costs of treating chronic anorexia. I hand out copies of research studies and scientific papers, making the case that eating disorders are physiological, not psychological, and should be covered the way pneumonia and every other disease is covered. I recount an urgent, abbreviated version of Kitty’s illness. I describe family-based treatment, contrast the thousands of dollars spent on Kitty’s hospital stay with the relatively low cost of FBT, and suggest that covering a few thousand dollars of therapy now will save them money in the long run.
Once or twice I look up from my notes and see people nodding thoughtfully. I have no idea who they are. I’ve been told there are several doctors in the room, a “patient advocate” (though as far as I can see no one at this table is on my side), some administrators, and I don’t know who else. I finish in exactly ten minutes, because an impatient-looking man near the head of the table is looking at his watch and I have the feeling he would take great pleasure in cutting me off midsentence. I stand up, collect my papers, thank the roomful of anonymous faces, and walk out on trembling legs.
The next morning—fifteen hours later—I get a letter from the insurance company saying they have “carefully considered” our case and have denied our appeal. Which means that