My doctor knew what care I needed. My insurance denied it | Opinion

I was diagnosed with anorexia when I was 17 years old. My extreme fear of gaining weight instilled a steely resolve to overexercise and pick at meals – no matter how hungry I felt. Eventually, I got too thin to be healthy.

My doctor recommended residential treatment. Only one local residential treatment center specialized in eating disorders. My mother and I toured the center, which was designed to be a warm, home-like environment, rather than a clinical ward. At that time, it accepted only women and girls, and I recall feeling relieved that I would be among people like myself, struggling with similar fears, fighting the same urges.

Then we learned our insurance wouldn’t cover it.

Instead, I was approved for four weeks at a generalized, institutional residential treatment center, where teens with a wide range of conditions – addiction, self-harm and behavioral issues – were treated together. There was no specialized care for eating disorders. No individualized treatment. I attended AA and NA meetings that weren’t relevant to my illness and did my best to make the most of them.

I stabilized and began eating again – not because the care was right, but because I was desperate to go home. After discharge, insurance covered four weeks of step-down care and outpatient therapy.

Anorexia has one of the highest mortality rates of any psychiatric illness. I was fortunate: I recovered. But many others are not as lucky.

The care I received was dictated by my health insurance. Someone else could receive far less care, simply because they have a different plan. This is the inequity baked into our health care system: two people can present with the same illness, severity and clinical needs – and receive different treatment plans. Not because their doctors disagree, but because their insurance plans differ. When coverage determines care, recovery becomes a matter of luck.

Rhode Island has an opportunity to change that.

State lawmakers are considering legislation (S2564 and H7945) which would require insurers to use the same standards providers rely on when determining whether behavioral health treatment is medically necessary. These clinical guidelines are developed by nonprofit professional associations, grounded in medical research, and reflect consensus across the field. Currently, insurers may rely on internal guidelines that can vary, lack transparency, or fall short of generally accepted standards of care.

Many Rhode Islanders face barriers to behavioral health care: higher costs, delays and limited provider networks. Additional state reforms can help improve access.

• Bills S2687 and J7946 would codify federal parity regulations into state law. Parity requires insurers to cover behavioral health services on the same terms as medical services, including comparable limits, costs and access to services. In 2024, new federal rules strengthened these requirements, but a recent legal challenge from a group of employers has left them uncertain. The administration has stopped enforcing key provisions and has urged states to pause their own enforcement efforts. Rhode Island does not have to stand by and accept reduced access to behavioral health care – we can enshrine these critical protections in state law.
• Bills S2467 and H7943 would eliminate prior authorization for in-network behavioral health care, removing one of the most common sources of delay. Blue Cross & Blue Shield of Rhode Island has had this policy in effect for years.

One in four Rhode Islanders lives with a mental health condition. Access to timely, appropriate care should not depend on an insurance plan.

When my doctor recommended care, he was guided by clinical expertise and clear standards of what I needed to recover. Our laws should require insurers to follow those same standards.

Because when it comes to behavioral health care, the stakes are too high to leave treatment up to chance.

Laurie-Marie Pisciotta is executive director of Mental Health Association of Rhode Island.