The downside of making postpartum depression sexy.

Health and medicine explained.
Aug. 30 2005 6:40 AM

Pricey Therapy

The downside of making postpartum depression sexy.

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As Brooke Shields testifies in her recent memoir, into many a postpartum life a little rain must fall. And evidently, a little Tom Cruise as well: someone who tops off a struggling new mother's depression with a downpour of judgment and misunderstanding. When Cruise blasted Shields on national television for using antidepressants to treat her postpartum depression, I thought, "Wow, he'd get along great with my health-insurance underwriters." They slapped me with a five-year penalty of raised premiums because I sought help for depression following the birth of my daughter.

In July 2004, my husband and I applied for personal health insurance from Anthem Blue Cross and Blue Shield of Virginia. He had left his job to start his own company, and I was self-employed, so we began looking for family coverage while the COBRA clock ticked. Because I was blessed with lifelong health, the "medical information" page of my application was relatively brief. I listed a prescription for Clomid, a fertility drug I'd taken while trying to conceive my daughter, and a single appointment I'd had with a psychiatrist after she was born, regarding the possibility of postpartum depression.

Shortly after we submitted our paperwork to Anthem's headquarters in Roanoke, the letters started arriving in our mailbox. My application was under review. More information was needed. Then another letter arrived. My husband and 9-month-old daughter had been approved for coverage at Level 1, the company's best rating. I had been rejected. The reason: the psychiatrist appointment.

I contacted Anthem. The company could not deny me coverage because, as stated on my application, I met all the criteria of the federal statute that protects health-insurance coverage for workers and their families when they change or lose their jobs. A week later Anthem approved me at Level 4, its worst rating. My husband and daughter's combined monthly premium was $237. Mine was $730.

During numerous calls to Anthem in the ensuing weeks, I learned that an indication of depression—including temporary postpartum depression—within a year of application sends a candidate down the Level 4 chute if legally she can't be rejected outright. "You were on medication for your condition," a representative noted during one of the calls. "It was a physician's sample," I explained, "and I discarded it after I learned the medication could pass into breast milk." The representative was not swayed. "I can only go on what the doctor's form says, and the form says Zoloft."

Over the next three months I appealed Anthem's decision. I argued that a single visit to a specialist should not be cause for charging an applicant the highest possible premium. Nor should taking a single pill of a medication that takes weeks to become effective be considered tantamount to receiving drug treatment. Trying to understand my low rating, I got a copy of the original form submitted to Anthem by the psychiatrist I'd seen. On the "diagnosis" line, she'd written "depression." I asked her to send a follow-up letter. In it she explained that during our one appointment, I'd had "depressive symptoms" that had subsequently been resolved.

Nonetheless, Anthem twice denied my appeal. The identical rejection letters assured me of the "thorough review" of my case. But it was hard to have faith in that when the underwriters failed even to get my name right on the letters, addressing me by my husband's last name after I'd told them in writing of the error. In the end, I had to opt for an inferior and yet more costly insurance policy, at $450 a month, than the one granted to my husband and daughter. After more calls to Anthem, I learned that the psychiatrist's appointment would bar me from a Level 1 rating for five years. I later filed a complaint with the Virginia Bureau of Insurance, but the state found no wrongdoing on Anthem's part. Insurers are free to establish their "own guidelines without regulatory interference," as long as those guidelines apply to everyone.

I couldn't believe, though, that taking an hour to meet with a professional about feeling overwhelmed and exhausted would brand me an insurance pariah. For the previous two years, I'd been singularly focused on staying healthy as I went through fertility treatments, carried my daughter in utero, endured a difficult labor that ended in an emergency Caesarean section, soothed her through three months of colic, and nursed her around the clock for nine months. While I was pregnant, I'd been bombarded with the message, "If you're depressed, seek help!" Glossy magazine articles, doctor's handouts, and childbirth classes depicted postpartum depression as both relatively common and treatable.

During the early weeks at home with my daughter, anxiety, fatigue, and loneliness defined my existence. Surely willpower could fix my sense of hopelessness, I reasoned at first. I was 35. I'd experienced hardship. But this was different. I'd never before forgotten the feeling of joy. I'd never been bereft of ideas about how to make things better.

Did I have "depression," as the psychiatrist initially wrote on the Anthem form? Or did I have "depressive symptoms," as she later clarified? In the shrouded world of insurance underwriting, these semantics seemed to determine my rating and premium. Yet I don't think many doctors realize the power of their word choice. And the pregnancy articles failed to mention that entertaining the idea that I needed help for PPD—even once—would have far-reaching repercussions. No one explained that my $250 appointment with a psychiatrist would constitute a grave risk to an insurer and cost my family thousands of dollars in raised premiums. Or that my low health-insurance rating could also adversely affect the cost and benefits of other kinds of insurance, such as life and disability. The postpartum depression awareness campaign to which Shields laudably devotes herself has worked in part. But knowledge of PPD leads to another baffling and difficult condition: being punished for advocating for your health.

This past February, I became eligible for Anthem's Level 3 coverage because a year had passed since my appointment with the psychiatrist. Still, my coverage continues to cost more than twice as much as my husband's. I won't be eligible for his Level 1 rating until 2009, and only then if no depression or other malady arises in the interim. To understand where our money is going, I Googled Larry Glasscock, Anthem's CEO, and learned that the company's "significant growth" reportedly grossed him upwards of $40 million in cash bonuses and stock awards in 2004.

Years ago, when I was in middle school, I used to draw braces on the gleaming white teeth of models in teen magazines. Since my struggle with postpartum depression, I like to conjure up my 12-year-old self, along with a splash of the late artist Jean-Michel Basquiat. In my fantasies, I swoop down on the piles of pregnancy journals in doctors' offices, sail onto the sets of talk shows, and hover above the handouts given out in childbirth classes. When I come across the line, "If you're depressed, seek help," I write, with my can of orange spray paint, "BUT PAY FOR IT IN CASH."

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