Insurance Companies Gone Wild

John Grohol at Psych Central had an important post yesterday concerning an insurance company in New Jersey that's refusing to cover some of its members for treatment of an eating disorder because of some things said members--children, as it turns out--have written about themselves online. The whole thing smacks of a case that's begging for a Supreme Court ruling once the matter has crawled through lower courts. Grohol, who's pretty much the godfather of mental health BBSs and websites on the 'Net, says it should give people who write blogs and post on websites and forums much cause for concern. I agree. I just don't know what to do with that concern.

Someday soon it might be central to my own life. I have not had health insurance in almost one year (I simply cannot afford it) and when I go back into the insurance market it will likely be as an individual and not as a group member, so I will potentially be much more exposed to something along the lines of what's up in New Jersey. I'm not going to live my life in fear of the bastards, but it does make you think.

Here's the gist of the Jersey story from the New Jersey Law Journal:

"Litigation over an insurer’s refusal to pay health benefits for anorexia or bulimia may turn on what is revealed from the alleged sufferers’ e-mails and postings on the social networking sites.

"The plaintiffs are suing in federal court in Newark, N.J., on behalf of their minor children, who have been denied benefits by Horizon Blue Cross Blue Shield of New Jersey.

"Horizon claims that the children’s online writings, as well as journal and diary entries, could shed light on the causes of the disorders, which determines the insurer’s responsibility for payment. New Jersey law requires coverage of mental illness only if it is biologically based.

"Horizon claims the eating problems are not biologically based and that the writings could point to emotional causes. It contends that access to the writings is especially important because the court has barred taking the minors’ depositions."

If a court won't allow a defendant to take a minor's deposition in real life, why would it allow evidence snatched from the child's cyber life to be introduced as evidence? How that question will be answered ultimately is beyond me, but beyond finding the insurance company's behavior to be sleazy and contemptuous (um, in the America I signed up for, major corporations and governments should stay the hell out of the private lives of citizens, especially those of children--except I know there are legitimate exceptions), I found myself chilled at the thought of writing today. Grohol, whose judgement I trust, says that blogs and social network posts and threads in forums are now fair game for lawyers and insurance companies.

Given the number of insurance companies and law firms who read this site and the degree to which everything I have written about mental health issues--be they personal or not--is indexed in search engines over the last four years, I would say I might be in a dicey position over all of this someday. Or maybe not.

Of course, things people write or post about themselves and their lives and the secrets of their souls have become weird fodder in America in recent years. You've all heard of variations on the following: the college student denied a teaching degree (and thus her state certificate) by a college because she had posted some pictures of herself drinking at a party. The basis for the denial was some jumped-up moral turpitude claim (I tend to think it's immoral not to drink at a party, but that's just me). And, you've surely heard of people who lost jobs or lost job offers because of things they'd posted about themselves.

I'm torn as to what to make of the dynamic and the tension between free expression on what is still a somewhat nascent medium and behavior by private businesses and public agencies. Yes, I think it's beyond lame when someone loses a sales job because they posted pictures of that special tattoo (Who the hell cares? Does anyone think customers are going to go snooping for that stuff?), but I think a legitimate interest is served when a police agency, say, pokes about the MySpace profile of an applicant, discovers that said applicant dropped acid at a rave one year before because dude is bragging about it on his profile, and denies said applicant a police job (yes, this really happened at a local police agency I am not at liberty to identify).

But we're getting into some really weird territory when insurance companies are using such postings to play games with patients' coverage. I guess I'm not surprised that they would give that tactic a go, but I am confused that state insurance commissioners have not carved into states law how citizens' online gibber-gabber can be used against them by health and auto insurers. And, more pointedly, what online communications should be protected.

Do we really want something someone posted on a MySpace group three years ago when they were depressed off their butts, for example, to be used against them when it comes time to get health coverage or new health coverage? I think not.

Grohol points out that people can take the tactic of limiting their online profiles, take their blogs private and make sure they only post to private online forums, especially where they involve discussing personal health issues. The tradeoff is that such moves will dramatically limit online discussions over time.

I've long been concerned about what I say about myself in print and online. A little over four years ago as I was writing a long essay about suicide and depression, I got into an extended conversation with a friend of mine who is a reporter at another paper (yes, reporters at competing papers do sometimes discuss what we are working on with trusted--OK, very trusted, blood oath--friends) about writing about the subject in the first person.

"You'll ruin your career," she advised. "I doubt it," I replied. "Besides, none of the experts I've interviewed on the subject seem to really know what they are talking about, and I cannot stand aside and print a bunch of BS when I know the truth to be different."

"Cover your ass," my friend told me. I didn't. If you are amused by such things, the resulting story is here. The online version has been read by well over 100,000 people and the print version was likely read by as many people when it came out in 2004.

I paid almost no professional price for what I wrote (OK, it helped), but I have paid a personal price. In the opinion of several of my friends, that article and the things I have written since here and elsewhere have hurt my dating life. I don't know if I agree with them completely, but from time to time over the last few years I have run into situations where I saw evidence for their point.

I'd tell you all about it. But someone might use it against me. I just hope it's not an insurance company or a bank or the government. Potential small-minded dates I can deal with (buh bye), but Blue Cross, Wells Fargo or the feds I'd have a tougher time addressing.