Thursday, June 05, 2008

BY JOYCE J. PERSICO

ROBBINSVILLE -- A Robbinsville family is one of two New Jersey plaintiffs to win a landmark lawsuit for eating-disorder patients against the Aetna Insurance Company due to the insurer's denial of claims to treat the condition as a biological ailment.

The suit is significant, according to attorney Bruce Nagel of the Nagel Rice L.L.P. firm in Roseland, because its consequences will affect not only the plaintiffs involved but all Aetna eating-disorder patients to come.

The Hartford, Conn.-based insurer will divide the $250,0000 settlement among approximately 100 families whose eating-disorder claims have been denied over the past seven years and change the way Aetna covers eating disorders, according to Nagel. The two main plaintiffs will receive $10,000 each and Aetna will pay up to $350,000 in legal fees to the Nagel Rice firm.

Nagel served as lead attorney in the class action suit brought by Robbinsville's Jeff Meiskin on behalf of his anorexic daughter and by a Bergen County father in the same situation with his daughter.

Meiskin's daughter, now 16, had her coverage cut off even though she required months of in-patient care. Aetna said her illness was a "non-biologically based mental illness." Coverage was limited to 20 outpatient visits per calendar year and 30 days of in-patient benefits.

Eventually, Meiskin enrolled his daughter at a Utah facility last January that required $26,000 to admit her and $30,000 monthly.

"The case is significant be cause it pays all families for claims denied over the past seven years and, going forward, it eliminates the limitations on coverage," Nagel explained. "It finally changes the way health insurers are dealing with eating disorders. What they do in New Jersey and throughout the country is treat an eating disorder as non-biologically based and they impose limits on coverage."

U.S. District Judge Faith S. Hochberg is expected to finalize the settlement June 16. Aetna spokesperson Cynthia Michener called the settlement "consistent with Aetna's goal of providing comprehensive, affordable coverage and service for all of its members." The company covers approximately 10-15 percent of New Jersey's insured residents, according to Nagel.

The attorney said, historically, such cases affect teenage women who were "literally removed from hospital care. Going forward, it could affect tens of thousands."

Nagel's firm also has an identical class action suit on behalf of eating-disorder patients in New Jersey against Horizon Blue Cross and Blue Shield pending in Newark federal court. Nagel referred to the Aetna suit as "the first settlement in a series of cases" his firm has on eating disorders.

Contact Joyce J. Persico at jpersi co@njtimes.com or at (609) 989-5662.

from nj.com website

http://www.nj.com/news/times/regional/index.ssf?/base/news-13/1212638904233240.xml&coll=5