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How Facebook Can Affect Your Insurance Coverage

How Facebook Can Affect Your Insurance Benefits
by Imei Hsu, RN, MAC, LMHC

With over 500 million users of Facebook worldwide, you shouldn’t be surprised who is on Facebook these days. Your dentist, your employer, your friends and family, and even your health insurance company may have a presence on Facebook. While it’s fun to set up events, get-togethers, and give your social network a slice-of-life status update a couple of times a day, you shouldn’t be surprised who is looking at your updates. Here’s how Facebook updates can affect your health insurance coverage.

What could your Facebook updates and photos be telling your insurer?

Enter Natalie Blanchard, a 30 year old IBM technician from Quebec. She has released her story The Los Angeles Times in 2009 about a medical leave she took in 2008 on the recommendation of her doctor. She was being treated for depression, and her doctor had suggested that she go on vacation. While on medical leave, had been receiving monthly disability benefits from her insurance plan, but these were severed without warning after the first year. Blanchard claimed that her insurance company had crawled her Facebook page, discovering pictures of her on her vacation. As you can guess, most vacation pictures include sunshine, smiles, eating and drinking, and what most of us would consider the “high life”. Her insurer considered her ready to return to work, and therefore benefits were terminated.

In the lawsuit that is scheduled to go to court in January 2012, Blanchard claims her insurer assumed this was a case of fraud based on her Facebook pictures and status updates, and that the insurer terminated benefits with studying the background of her benefits. She also claimed her doctor was not contacted before the benefits were terminated. If you don’t know this, it is standard practice in medical cases that the treating physician or nurse is contacted by an insurer case consultant (often times a medical practitioner) to determine the need for benefit based on the medical history of the client.

As a therapist, I find this trend alarming. But even if you’re not a clinician, you should be concerned. The original articles were released in 2009 and 2010, yet I consistently see people using their Social Media updates such as Facebook without an awareness of who might be tracking their posts. I also find it disturbing because disease and dysfunction does not follow a consistant pathway of suffering 100% of the time in ways that can be detected from the smiling face of a person on vacation.

Case in point: a friend of a close friend spent time skiing, running, and sharing meals with my friend all the way up to about a couple of weeks before she took overdosed in a hotel room. Her suicide note indicated that she had been planning her suicide for some time, but her friends and family were shocked. The months before her suicide had been filled with smiley-faced pictures of herself traveling around the world, a brief but intense romance, and dreams of the future. At her wake, the guests were still in a state of shock and grief, and to this day, I am sometimes haunted by her vibrancy and verve.

During the years of her struggle with depression, she had done what so many others do: they fight it, they get professional help, they try to live life the best they can, and when there are moments when the depression lifts, they go on vacations, eat and drink, fall in love, and struggle on. Those momentary lifts do not mean the depression is over and done with. Clinicians understand that a lift in depression can also be a time when a severely depressed person has just enough energy to plan a thoughtfully executed suicide.

While the insurer of Natalie Blanchard claims they did not terminate her disability benefits based on her Facebook status updates and photos, they are not denying that these updates and photos were viewed. What should you learn from this?

1. Insurers can and do look at your Facebook status updates and photos, and you cannot legally stop them from this practice. They have the right to search for evidence of fraud or foul practice. Any business can do the same thing. In January 2010, Mark Zuckerberg declared to the world that privacy in the online age was over.

2. You can change your privacy settings on Facebook to limit who can see your posts. However, you should understand that your Terms of Use on Facebook does not ensure your privacy, and Facebook’s position has never been to ensure your privacy.

3. Educate your physician’s office. If you are using insurance benefits for your healthcare and need special coverage based on a medical condition, discuss with your doctor your concerns. Your doctor should be directly contact anytime your benefits are increased, decreased, or terminated based on your medical condition.

4. Take a moment to consider what it is you are sharing on Facebook, Twitter, and other Social Media platforms every time you type. Notice what ads come up on your page when you type in keywords like cancer. At minimum, bots crawl your pages and emails on certain platforms, using keywords to generate ads that are sent to you. Test this: mention that you’re watching your weight, and see how many ads come up for everything from P90x to weight loss yoga. In a similar way, insurers can sift through your public posts to see what you’re broadcasting, and this can be used as evidence against you in a similar way lawyers are using this for divorce cases and employers are using it when interviewing a potential candidate for hire.

This post is not about scaring the bajesus out of you. It’s about educating users so that you can enjoy the best that the Internet has to offer while protecting your best interests. Now go: Skype, text, update, and post your photos. Only be careful, and if you’re not sure how something will be construed, save it for your private enjoyment.

For another link to the story about Natalie Blanchard’s case, take a look at this law blog.

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Psychology vs. Psychiatry

When you need to see a helping professional for a mental health issue, finding the right person to help you can be difficult. One of the first things you need to determine is what kind of helping professional is the right one for you. Do you need to see a psychologist, psychiatrist, psychotherapist, or coach? This blog post will make it clear your options, and you should be better able to choose the right helping professional for your needs.

Psychology vs. Psychiatry
Both psychologists and psychiatrists can conduct psychotherapy sessions, but their training is different. Both are able to do research, and both often have specific areas of expertise with different populations or age groups. Psychologists with an emphasis in conducting psychotherapy sessions usually have a PsyD degree. They often conduct tests and evaluations of these measurements. Psychiatrists go to medical school which includes general medicine, and after a residency, they may choose a specific area of emphasis within the psychiatric stream. Psychiatrists can prescribe medicine, while psychologists do not.

Psychotherapists, like myself, have a Master’s degree and can conduct therapy sessions like psychologists and psychiatrists. They do not dispense medicine, but they may have experience or other degrees that may assist you with medication management. In my case, I am a Registered Nurse, so I often help your physician manage your medications, whether psychotropic or not. Psychotherapists also tend to specify their scope of practice as to who they are best at helping, and you should be able to see that list of conditions, issues, and age groups on a brochure or their website.

Coaching
Coaches come from a wide variety of backgrounds of which no particular college degree is required for practice. Depending on a coaches stated area of expertise and years of experience, a coach can usually help with issues and situations that require skill acquisition, decision making, and planning that do not include the investigation of the client’s emotional past. Coaches do not need to have any kind of psychology degree to practice, but they must show minimum competency to provide coaching services. There is currently no one way to become a coach, although there are now several certifying bodies, such as Coach U and the International Coach Federation, both of whom have provided ways for coaches who get training to be recognized and credentialed for their training. The US does not currently require coaches to be certified by either of these bodies. Because helping professionals who do professional licenses, such as psychotherapists, obtain the minimum competency required to be a coach, these professionals often make great coaches by adding on specific ways of focusing their work to the realm of coaching.

Which helping professional do you need? The answer depends on what you’re looking for. If you have a four-year-old child who won’t talk, you’ll likely want to do some tests and measurements; therefore, a child psychologist will likely be who you’ll seek for your child’s diagnosis. If you and your spouse are having marital difficulties and neither of you needs medication for a pre-existing psychiatric condition, you can choose from all three kinds of professionals, though a therapist may be all you need. If you’re a struggling with a career change late in life but you know your “issues”, career coaching sessions might be up your alley, while a therapist could help if part of your decision-making process requires you to delve into your personal blocks, anxieties, and concerns.

Finally, I get asked by friends about how to pick a “good” therapist, whether that’s a psychiatrist, psychologist, or psychotherapist. Ultimately, it often has little to do with credentials. You’ll know you found the right one for you when that person makes you feel like you are heard, understood, and helps you come to a better understanding of your past, present, and future. When you feel your therapist in your “corner”, that’s usually the right therapist for you. The rest is situational: location of the therapist’s office, available hours, and cost of the sessions.

But you don’t have to take my word for it. Check out this excerpt from WebMD:

Whose Therapy Is Best? Ask any of the three professionals who provide the best psychotherapy, they will all tell you their own specialty is the most skilled. You could have a great therapeutic relationship, or a bad experience, with any of them.

“The professional credentials alone don’t determine that someone would be helpful to any particular patient,” says Rebecca Curtis, PhD, a professor of psychology at Adelphi University in Garden City, N.Y., and director of research at the W.A. White Institute of Psychiatry, Psychology, and Psychoanalysis in New York.

Nevertheless, she says experience and training matter at least as much as the therapist’s personal qualities and the relationship between the patient and the provider. She advises people to interview a potential therapist carefully. Although you may want to get right to talking about your issues, “ask them specifically about their training during the initial session,” she tells WebMD.

“Everybody thinks they can sit down and talk to people and be helpful,” she says, “but it really helps to have a lot of experience and training.”