Shown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Racer on June 14, 2008, at 8:54:53
My insurance company denied my request for treatment. They said that I didn't need residential treatment. Now, there are a few irregularities in their review process -- it seems, for instance, that their doctor called my doctor for more information related to the review process AFTER the date on which the decision was made. I'm thinking that might be interesting information to use during the appeals process.
The insurance company did offer to send me to a lower level of care, and intensive outpatient program about half an hour from here. I had contacted them years ago, and decided that it would not meet my needs. Some of you may remember that I had a very traumatic experience with treatment a few years back, so I'm not especially open to trying treatment that looks suspicious to me. And this looks and sounds custom made to traumatize me again.
It's moot, though. The program will do the assessment, but if I can keep my weight down until they do, I won't qualify for their program. Their paperwork will reflect the fact that their protocol indicates I require residential treatment.
At this point, of course, I've gotten hit with so much [excrement] at home, and had another crossfire with my therapist, and am running out of OP benefits for the year -- which means I may have to stop therapy... I'm just feeling so overwhelmed, and as though we've lost that window of opportunity to get good work done. I don't know that it's worth trying anymore.
So, I would say, I'm not in great shape.
Posted by Midnightblue on June 15, 2008, at 0:00:09
In reply to Insurance denied request for treatment, posted by Racer on June 14, 2008, at 8:54:53
Racer,
I'm so very sorry about this! It would seem without the benefit of out patient therapy and the continuing problems at home you will soon qualify for residential treatment, though I think you should now. I'm still hoping for you.
Hang on!
Keep trying!
Though I know it is so hard.
MidnightBlue
Posted by Phillipa on June 16, 2008, at 12:39:22
In reply to Re: Insurance denied request for treatment » Racer, posted by Midnightblue on June 15, 2008, at 0:00:09
Seems from that letter SLS wrote on the meds board about a month and half ago about them doing away with residential programs in NJ and the fact the NC already has that we have definite insurance problems concerning mental health. Racer keep fighting for that program you deserve it. Sorry you feel so bad too. Love Phillipa
Posted by overtheedge on June 16, 2008, at 13:40:40
In reply to Insurance denied request for treatment, posted by Racer on June 14, 2008, at 8:54:53
racer,
i am so sorry to hear you were denied, wish there was more that i could say or do, but i am always here if you need to talk or vent.
Posted by Poet on June 16, 2008, at 17:54:55
In reply to Insurance denied request for treatment, posted by Racer on June 14, 2008, at 8:54:53
Hi Racer,
I really feel for you. You know you need to go residential, your T and pdoc know it, but the (I'll be civil) gosh darn insurance company made their decision without gathering the facts and that in my opinion is something that should be brought to the intention of your State's insurance board. At least it'll let you vent to the people who can take action.
I realize residential care is expensive, but if it is recommended by bonified mental health professions you would think that insurance companies would be required to contact everyone involved with the patient's care before making what I call an arbitrary decision.
I don't think you should go to the day program even if the insurance will cover it as you have looked into it and you know it is not what you need.
I hope you can appeal to the insurance company and I strongly recommend contacting the State insurance commission.
Take care and remember I am here for you.
Poet
Posted by happee_place on June 17, 2008, at 0:25:14
In reply to Insurance denied request for treatment, posted by Racer on June 14, 2008, at 8:54:53
((((((((((Racer))))))))))))
hi!! ive never posted here before but have read a lot and have been following up reading the updates on this thread. I have been to residential and remember girls i was there with, talking about the fights they had with the insurance and how discouraging and frusterating it was to actually get there. And then yet other girls who right in the middle of some hardcore, breakthrough getting to the bottom of some serious sh*t - get yanked from treatment because their insurance said "times up shes had enough" grrr makes me want to inflict an E.D. on them.
Having an E.D. is about inner turmoil so i understand how it wouldnt help at all that they are denying you. And it adds fuel to the fire in so many ways. I for one and im sure so many here am so proud of you for being so open and wanting to go!!! I encourage you to stick with trying to get help. E.D's are so complex by the time someone wants help its been so many years leading up to programing your mind that way that it takes years to undue. Treatement is good because it teaches you the tools to use in those years of undoing.
I know the one i wen to Remuda Ranch in Arizona is a very well known awesome treatment with some crazy percentage rate of success! And although its rediculously expensive the 2 nice things about it is they have scholorships for families in financial need and they have payment plans. So literally like a downpayment on a car or something (actually its more like 3 cars) you can make payments for the rest of your life if you have to. Point is they work with people. It is so expensive because its super ligit. Its 100% inpatient so there are dr's therapist, nutritionist and aray of counselors, nurses etc.. working 24 hours a day in the same home you are living. You should research it and if it seems unbearable i have resources to others. Sounds kind of crazy to spend so much to get help BUT think of it this way - everyone has debt somewhere be it student loans, homes, cars and thats not including the majority of america who have debt from credit cards etc... where they have nothing to show for it. If people are willing to be make a payment each month for these things that are all material certainly, hopefully you can see how beneficial a payment a month to give you your life back is so much more valuable, than equity 'and shiny toys. I personally am on the monthly for the rest of my life plan lol but ya know what i dont care because E.D's dont just go away. If it werent for me i would have had at least 3 full blown relapses by now. But the tools i learned there, just like a degree no one can take from me - its engraned in my mind, and i have never once regretted any part of it.
It would be better if the insurance paid for it which they should rat bastards (maybe someday this will change) but if they cant still pursue other alternatives. I promise even if you have to spend money you werent expecting to spend its worth every penny to give yourself a chance to really live and not painfully walk through the motions.
here is a hug((((((((((((((()))))))))))))))))) dont give up sweety!!! YOU ARE SO WORTH IT
Posted by overtheedge on June 18, 2008, at 12:00:45
In reply to (((((RACER)))))), posted by happee_place on June 17, 2008, at 0:25:14
they also i believe open a remuda ranch in virgina this yr.
Posted by happee_place on June 18, 2008, at 17:45:48
In reply to Re: (((((RACER)))))), posted by overtheedge on June 18, 2008, at 12:00:45
oh thats bad *ss - its good to know they are expanding!!! It says a lot about their success rate!! Anyone know if she is o.k.??
Posted by Racer on June 18, 2008, at 21:26:23
In reply to Re: (((((RACER)))))), posted by happee_place on June 18, 2008, at 17:45:48
I'm, you know, OK enough, I guess...
My insurance company denied the request for residential treatment, and suggested a local day program. I had my assessment there today...
And, uh....
Their recommendation was for the same program my T recommended... They won't take me, so that point is moot.
Thanks for caring.
Tomorrow I'll talk to my therapist about whether or not I'm going to appeal.
Posted by Midnightblue on June 18, 2008, at 22:49:42
In reply to Assuming I am she... ;-) » happee_place, posted by Racer on June 18, 2008, at 21:26:23
And your T recommended the residential place in Florida? Sorry, my brain is wobbly trying to keep this all straight.
Racer, you continue to be in my thoughts and prayers. Right now I couldn't fight an insurance thing if I had to. I wish you well.
MB
Posted by happee_place on June 19, 2008, at 1:17:33
In reply to Re: Assuming I am she... ;-) » Racer, posted by Midnightblue on June 18, 2008, at 22:49:42
> And your T recommended the residential place in Florida? Sorry, my brain is wobbly trying to keep this all straight.
>
> Racer, you continue to be in my thoughts and prayers. Right now I couldn't fight an insurance thing if I had to. I wish you well.
>
> MBi think she is refering to the day program which is outpatient which in my opnion doesnt work. i could be wrong. Anything might help BUT really, honestly i dont want to be discouraging but when you go into a place during the day, see therapist and such ect.. and then go home to the environment that contributed to your current e.d. state of mind just not the best situation for obvious reasons. I did not even want to get well or see the point until i was half way throgh of mine and that was being on lock down totally removed from my normal environment. Especially if her husband has a bit to do with how low she is. I dont know how therapist dont see this. Really sometimes the only people i think understand people with e.d.s are those that have had them. Lets pray the judge has had one. Appeal their assess racer.
im sorry for all this.
im here any time you want to talk.
im haveing a rough time right now but am able to be so strong for others, if its any consolation:/love happee_place
Posted by Racer on June 19, 2008, at 11:26:41
In reply to Re: Assuming I am she... ;-), posted by happee_place on June 19, 2008, at 1:17:33
> > And your T recommended the residential place in Florida?
>
> i think she is refering to the day program which is outpatient which in my opnion doesnt work. Appeal their assess racer.
>
>Hi, thanks to both of you for your concern and encouragement with this situation.
The program my therapist recommended is the residential program in Florida. The IOP is what the insurance company recommended, when they denied the residential program. My therapist did say I should go for a few days and flunk out, but I wasn't in favor of that for good and just reasons.
I'm happy with the assessment, since I wanted to be rejected by the IOP -- if only so that I wouldn't have to fight with my therapist about why I wasn't going to go...
Thanks again for thinking of me, and I'll let you know what I decide about appealing the denial of treatment.
Posted by Maxime on June 22, 2008, at 16:15:36
In reply to Insurance denied request for treatment, posted by Racer on June 14, 2008, at 8:54:53
I'm really sorry Racer ... it's not fair!
When I watched the documentary THIN, I couldn't believe how they had to leave when insurance ran out ... whether they were well or not.
I hope you find a solution.
Maxime
This is the end of the thread.
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