Misunderstandings hurt

This story will upset every caregiver and parent of a young person suffering from an eating disorder. Horizon Blue Cross Blue Shield of New Jersey is refusing to pay for care for three children allegedly suffering from anorexia and bulimia. To defend their position, the insurer wants all of the children’s emails, diaries and anything else they’ve written or shared with others about their conditions, including entries on Facebook and MySpace.

New Jersey Law Journal reported last week that:

...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....

In December, U.S. Magistrate Judge Patty Shwartz ordered the plaintiffs to turn over by Jan. 15 the children's e-mails, diaries and other writings about their “eating disorders or manifestations/symptoms thereof, and related health conditions" that had been "shared with others, including entries on Web sites such as Facebook or MySpace."....It also requested that all the plaintiffs be required to identify their e-mail accounts, and those of their families, and produce at their own expense a mirror-image copy of the hard drive for every computer used by their family....

The normal biological and psychological effects of starvation and its roots in anorexia and bulimia were first demonstrated more than fifty years ago, as mentioned earlier this week. Sadly, conventional wisdom often attributes anorexia and bulimia to being mental diseases and something brought on by bad behaviors or psychological issues. It’s hard to watch the pain that such misinformation brings to sufferers, who’ve been led to believe they’re mentally defective or who are being hurt by the prejudices of others.

But, healthplans should know the research and understand the biological components of most eating disorders. That they don’t and are refusing to assist these children, who sound to have been identified by healthcare professionals as in need of treatment, is difficult to justify.

There are abundant illustrations that insurers are not always proponents of evidence-based medicine. Last month, Anthem Blue Cross and Blue Shield Foundation, gave a $96,000 grant to fund the Signs of Suicide program to screen every high school and middle school child in the St. Louis area. Yet, as recently reviewed, there is no to support for such screenings, according to the latest review of the evidence by the U.S. Preventive Services Task Force. There are, however, troubling reports of potential harms.

The NJ Law Journal said that a bill that would amend the Mental Health Parity Law and mandate coverage for eating disorder treatment is currently before the Budget and Appropriations Committee. It would automatically decide this case.

Portfolio just published a follow-up article on these lawsuits and the fact that case law on discovery of materials posted on social networking websites is just developing. Phillip Malone, director of the cyber law clinic at the Berkman Center for Internet & Society at Harvard Law School, was quoted as saying that today’s generation has grown up online and has different privacy expectations. They “believe they can put material on the Internet with the expectation that only a limited group will see it.” Privacy protections are far less when someone has chosen to disclose the information, however. The article describes other cases, however, that used a trail of evidence left on the internet or in emails. Young people and their parents may want to read this article and discuss this aspect of internet safety.