Prozac: Hazard to your health insurance

In addition, more and more children are taking such medication, according to a 2006 study in the journal Ambulatory Pediatrics. In 1995, of children younger than 13, only 8.6 of 1,000 were on anti-psychotic drugs. By 2002, it had risen to 40 out of 1,000.

Among the public, the stigma about seeking therapy has lessened, said Carolyn Rabinowitz, president of the American Psychiatric Association, in part because of the willingness of famous actors, celebrities and athletes to publicly admit they have been treated for depression, postpartum depression or anxiety. Also, more and more people know someone treated for a mental-health disorder who got well or improved, she said.

That hasn't made getting an individual insurance policy any easier, though.

"Anything they can do to exclude payment, they do. Their business is to not pay money," said Rabinowitz.

"It's gotten worse, and it's a real problem for people," agreed Bill MacGillivray, president of the National Coalition of Mental Health Professionals and Consumers. "If you seek care, you are seen as damaged by the insurance industry."

There's nowhere to go

In the arcane market for individual coverage, very few consumers seeking such insurance have protection under federal law.

In roughly a dozen states, including Arizona, California and Delaware, the Health Insurance Portability and Accountability Act (HIPAA) requires insurers to sell you a health-insurance policy without coverage limits, if you have had at least 18 months of continuous coverage and are moving from a group policy to an individual policy. However, HIPAA does not limit what can be charged.

Premiums can jump to double, triple or even 10 times higher than the average amount, said Pollitz.

Insurers do not disclose their underwriting guidelines, and insurers interpret diagnoses in different ways.

For the most part, there is little rate regulation, with only five states -- Vermont, New York, Maine, New Hampshire and New Jersey -- guaranteeing access to the individual market at community-rated premiums not based on health status.

Protecting privacy

A survey on medical privacy, released in November 2005 by the California Healthcare Foundation, found that 13% of American adults say they have done something "to protect the privacy" of their medical history. Younger respondents, those under 45, were more likely to have engaged in privacy-protective behaviors. Those include:

• Paying out of pocket to avoid submitting a claim.

• Not seeking care, such as diagnostic tests, to avoid disclosure.

• Asking their doctor not to write down a health problem or to record a less-serious condition.

• Giving inaccurate or incomplete information on a medical form.

• Asking therapists not to take notes or to see a patient under an assumed name.

"People should not have to sacrifice their health in order to shield themselves from job discrimination and loss of health benefits," said Janlori Goldman, a researcher at Columbia University's College of Physicians and Surgeons. Still, many people are "fearful that their medical information will be used against them," she said.

There's good reason for such fears. Insurers share information through organizations such as MIB, a Massachusetts association of insurers that gathers health and other information on consumers, almost like a credit report.

MIB compiles information on those who have applied for insurance in the individual market, such as for life, disability or health coverage. That information is coded and shared with member insurance groups who receive new applications. A consumer is notified about MIB on the application. (Consumers can request their free report on the MIB site.)

"An insurer's goal is to understand the consumer they are underwriting and properly gauge the risk. Otherwise, they would be insolvent," said David Aronson, spokesman for MIB, a not-for-profit group.

If you are looking for coverage in the individual market, be prepared for scrutiny. Health-care applicants are asked to fill out detailed, multipage questionnaires about their health care. One of the first questions is usually whether you have diabetes, Pollitz said.

After they receive the application, insurers turn to information gatherers such as MIB and other sources to double-check what an applicant has disclosed.

So now you need insurance

Lying on your health-insurance application form is never a good idea. It's considered insurance fraud and the insurer can cancel your policy (just when you might need it) if you are caught. As more and more data is warehoused electronically, it is easier for insurers to share information about you. What you can do:

• Answer the questions to the best of your ability and be truthful.

• Hire an experienced health-insurance broker who knows the underwriting criteria of several individual insurers.

• After an appointment with a therapist, look at the number on the claim form you receive from the therapist. Ask what your diagnosis is, so you can best know how to proceed.

• If you are denied, ask your doctor to write a letter supporting your re-application, especially if you are no longer in counseling or no longer taking a prescription drug that got you denied.

To learn more about protections for individual health insurance offered by your state, go to Georgetown University's Health Privacy Project.

Updated Sept. 2, 2008

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