Harlick

Plaintiff Jeanene Harlick suffers from anorexia nervosa. The question before us is whether Blue Shield was required to pay for her care at a residential treatment facility, either under the terms of her insurance plan or under California’s Mental Health Parity Act. We conclude that her insurance plan does not so require, but that the Mental Health Parity Act does.

I. Background

A. Harlick’s Treatment at Castlewood

Jeanene Harlick, who is now 37 years old, has suffered from anorexia for more than twenty years. In early 2006, when she was a clerk at the Pacific Construction & Manufacturing Company, she relapsed and began undergoing intensive outpatient treatment. She was then enrolled in the company’s health insurance plan through Blue Shield (“the Plan”), which paid for the treatment.

In March 2006, Harlick’s doctors told her that she needed a higher level of care than the intensive outpatient treatment then being provided. Blue Shield employ ees told Harlick on the telephone that residential treatment was not covered under her Plan, but that partial or inpatient (full-time) hospitalization would be covered if Blue Shield determined that it was medically necessary.…