A health insurance company in New Jersey has refused paying for the health care costs some teenagers with eating disorders, stating that law requires that they would be covered if only the illnesses were biologically based, and not influenced by emotional issues and peers, and, um... MySpace.
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 MySpace and Facebook.
Wait, what? I thought eating disorders WERE emotionally based?
Can you "catch" an eating disorder physically? Some say it's possible that the tendencies are passed down, like any addictive or psychological issue.
Source:
Anorexia is caused by the merging of environmental
factors in an atmosphere of physiological susceptibility.
Children can be born with a predisposition to developing
anorexia through genetics and temperament. There has been
shown a direct correlation between inherited addictions and
the development of clinical eating disorders, including
both anorexia and bulimia.
Other predisposing factors that are environmental in
nature include the influence of peers and the media, as
well as communication and problem solving patterns in the
family. The good news is that when children are taught by
their parents to recognize feelings so they can address
problems and find effective solutions early in life, they
will have less of a tendency to need or want to turn to an
eating disorder such as anorexia to "solve" their problems
for them.
In addition, the nature of one's eating lifestyle
(healthy or not so healthy) will have a great influence on
whether or not a person may become a victim of extreme,
disregulated or dysfunctional eating habits or obesity
later in life.
Are online blogs, emails and diaries giving away too many secrets? Are they creating an unfair advantage to health insurance companies to spy on their claimants? You betcha. These insurance companies are looking out for their bottom lines, and ED's are quite expensive to treat, and have a huge relapse quotient.
Here are two examples of treatment programs I pulled off of a Google search:
Acute 24 hour care is $1,100 per day and includes individual psychiatrist visits.
Extended Partial Hospitalization (10 hour PHP) care is $800 per day and includes individual psychiatrist visits.
Traditional Partial Hospitalization (6 hour PHP) is $600 per day.
Intensive Outpatient Program is $275 per day.
The programs even say, "We will attempt to pre-certify treatment with your
insurance company when appropriate. There is often a
delay of several weeks or even months before your
insurance company will reimburse you for the cost of
treatment. Almost all of our patients receive some level
of reimbursement from their insurance companies but
insurance reimbursement varies widely by company and
coverage type. It is a good idea to consult your
insurance company directly prior to admission to
determine what level of insurance reimbursement you can
expect. "
Families aren't usually prepared for this type of expense.
The insurance companies are most likely hit with many kids that need treatment, and apparently they are working hard to avoid paying. What can they do? Google the kid. Find her (or his) blog.
"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."
What have we learned? Don't tell your blog anything you won't tell your health insurance company*. Younger kids may not "get it," and may rebel and post hugely inappropriate online babble. (Oh be quiet, I know.)
Adults with ED, I guess it's a risk you take, unless you have figured out how to be completely anonymous online, including IP address blocking (like your online stalker would do to visit you). This ticks me off - because - what about folks that post in online support forums for genuine help? Are those records likely to be used against them? Probably. It's pretty sad that people can't be honest without CYA. Just look around, especially in this post weight loss surgery community, most of our peers are either previously afflicted with eating disorders, currently afflicted, or will be. Will WE be denied coverage if WE find ourselves in need of services?
Probably. (Says the girl with the bill for $1300.00 for an 500 foot ambulance ride from a hospital outpatient clinic to an emergency room.)
*We could interchange this to Potential Employer, Ex-Employer, Lawyer, etc.
A health insurance company in New Jersey has refused paying for the health care costs some teenagers with eating disorders, stating that law requires that they would be covered if only the illnesses were biologically based, and not influenced by emotional issues and peers, and, um... MySpace.
Wait, what? I thought eating disorders WERE emotionally based?
Can you "catch" an eating disorder physically? Some say it's possible that the tendencies are passed down, like any addictive or psychological issue.
Source:
Are online blogs, emails and diaries giving away too many secrets? Are they creating an unfair advantage to health insurance companies to spy on their claimants? You betcha. These insurance companies are looking out for their bottom lines, and ED's are quite expensive to treat, and have a huge relapse quotient.
Here are two examples of treatment programs I pulled off of a Google search:
Acute 24 hour care is $1,100 per day and includes individual psychiatrist visits. Extended Partial Hospitalization (10 hour PHP) care is $800 per day and includes individual psychiatrist visits. Traditional Partial Hospitalization (6 hour PHP) is $600 per day. Intensive Outpatient Program is $275 per day.The programs even say, "We will attempt to pre-certify treatment with your insurance company when appropriate. There is often a delay of several weeks or even months before your insurance company will reimburse you for the cost of treatment. Almost all of our patients receive some level of reimbursement from their insurance companies but insurance reimbursement varies widely by company and coverage type. It is a good idea to consult your insurance company directly prior to admission to determine what level of insurance reimbursement you can expect. "
Families aren't usually prepared for this type of expense.
The insurance companies are most likely hit with many kids that need treatment, and apparently they are working hard to avoid paying. What can they do? Google the kid. Find her (or his) blog.
What have we learned? Don't tell your blog anything you won't tell your health insurance company*. Younger kids may not "get it," and may rebel and post hugely inappropriate online babble. (Oh be quiet, I know.)
Adults with ED, I guess it's a risk you take, unless you have figured out how to be completely anonymous online, including IP address blocking (like your online stalker would do to visit you). This ticks me off - because - what about folks that post in online support forums for genuine help? Are those records likely to be used against them? Probably. It's pretty sad that people can't be honest without CYA. Just look around, especially in this post weight loss surgery community, most of our peers are either previously afflicted with eating disorders, currently afflicted, or will be. Will WE be denied coverage if WE find ourselves in need of services?
Probably. (Says the girl with the bill for $1300.00 for an 500 foot ambulance ride from a hospital outpatient clinic to an emergency room.)
*We could interchange this to Potential Employer, Ex-Employer, Lawyer, etc.