It's way past my bedtime, and tomorrow I start my new job and a new semester of classes. I really should be sleeping. I want to start things off right. Feeling a bit nervous about tomorrow. I think the majority of it is b/c we are in a new city where we know no one. It's not like starting a new job where I can meet up with the same friends after work or come home to the same roommate. Everything is new. While I am very excited about all of these changes, I must admit that I am not getting through this anxiety free. All I need to do is make it through this week. After that, I think the newness will pass and I will get into a routine. That's the way it always goes.
Oh, I also think I'm feeling a little stressed because I didn't realize marrying a man in the Army meant I was marrying the Army too. I know, apparently I'm extremely naive when it comes to this stuff. I knew I would move where ever the Army said, and I would do things with other army wives, but I had no idea there were books out there called "The Army Wife's Social Code of Ethics". What in the world? Apparently, my naivete could get us both blacklisted within the first month of our marriage. I've ordered the books. If I mess up, I don't want it to be out of ignorance. Apparently, since fiance recently made Captain, there's a lot more that goes along with being an Army wife. I think I will be doing lots of involuntary volunteering and there is a hierarchy among the wives just like among the soldiers. Oh, so much to learn! The wedding is 9 months away so I have plenty of time, but that was quite a shock to me to learn over the weekend. Good thing I love fiance so much!! I had no idea marrying him meant I was joining the Army as well.
Fiance also told me there's a good chance I won't be able to spend next Christmas with my family. I don't know what that means, and he didn't elaborate. I will be so happy when he gets home and he can't use the excuse, "I can't tell you, we're not talking on a secure line."! I've never missed a Christmas with my family. Even one time when I really needed IP treatment, I convinced my treatment team and my parents to let me be admitted on Dec. 26 so I could spend Christmas with my family. I know what you're thinking. It's a year and a half away, and it's the Army so things will probably change 5000 times between now and then, and you're right. I won't fret over this long. Just felt like I had a lot of big information to take in over the weekend and haven't really processed it yet.
God is good and He will work everything out. "For what man has added even a minute to his life by worrying?" - wish I could remember that Bible verse of the top of my head. I know it's New Testament and Jesus said it.
And with that thought in mind, I'm going to sleep. Night all!
Sunday, August 30, 2009
Thursday, August 27, 2009
Smart therapist *May trigger*
So, I guess it's part of the reason I continue to go to therapy... Not only to deal with childhood hurts and current difficulties but also to gain insight and perspective. I must say I am mostly grateful, but sometimes after I talk over something with her, the answer makes so much sense that I wonder why I didn't see it myself?
Today in therapy we talked about the nightmare I had Monday night. After talking over with therapist the dream now makes sense. A lot of the later, more extensive abuse took place in my abuser's basement. The new apt. that I just moved into is in the basement of a house and a family lives in the house upstairs. While my new apartment is completely finished, furnished, and looks nothing like the basement from my childhood, it is very feasible that the literal similarities of being in a basement witn an older man living in the house above us could have majorly triggered parts. Thankfully therapist and I both think these feelings will be passing the longer we stay and see that this situation is a safe one and very different from our childhood memories. The family that owns the house and the apartment have been nothing but great to me. They are safe people and hopefully this will prove to be a great learning experience for all of us.
In the meantime, we will just continue to talk things out in therapy and pray that the nightmares get less and less everynight until they're gone. We also aren't under any contract at this place, so should our symptoms get worse as time goes on (which I highly doubt), we can move out at any point into a new place. I think that's comforting to some inside. We are not trapped in this living situation at all.
We're out of town for the rest of the week and weekend, so maybe when we're back in the apartment Monday night we'll be rested and ready to give the new place a go again.
Today in therapy we talked about the nightmare I had Monday night. After talking over with therapist the dream now makes sense. A lot of the later, more extensive abuse took place in my abuser's basement. The new apt. that I just moved into is in the basement of a house and a family lives in the house upstairs. While my new apartment is completely finished, furnished, and looks nothing like the basement from my childhood, it is very feasible that the literal similarities of being in a basement witn an older man living in the house above us could have majorly triggered parts. Thankfully therapist and I both think these feelings will be passing the longer we stay and see that this situation is a safe one and very different from our childhood memories. The family that owns the house and the apartment have been nothing but great to me. They are safe people and hopefully this will prove to be a great learning experience for all of us.
In the meantime, we will just continue to talk things out in therapy and pray that the nightmares get less and less everynight until they're gone. We also aren't under any contract at this place, so should our symptoms get worse as time goes on (which I highly doubt), we can move out at any point into a new place. I think that's comforting to some inside. We are not trapped in this living situation at all.
We're out of town for the rest of the week and weekend, so maybe when we're back in the apartment Monday night we'll be rested and ready to give the new place a go again.
Wednesday, August 26, 2009
A little better
Last night's sleep went a little better. Rather than being physically traumatized in my dreams, I just dreamt that my wedding day was an absolute disaster, and the worst part was at the end of the dream fiance and I weren't even married. I assume last night's dream is common for many brides-to-be, so it wasn't near as difficult to shake.
Still, the dreams were so vivid, I had a really hard time waking up this morning. I haven't done any med changes recently, so those that help me sleep are still at the same dosage. I'm really hoping this is a phase that will pass quickly. It is no fun waking up feeling like you've run a marathon in your sleep and feeling more tired than when you lied down the night before.
Here's hoping night 3 will be the charm....
Still, the dreams were so vivid, I had a really hard time waking up this morning. I haven't done any med changes recently, so those that help me sleep are still at the same dosage. I'm really hoping this is a phase that will pass quickly. It is no fun waking up feeling like you've run a marathon in your sleep and feeling more tired than when you lied down the night before.
Here's hoping night 3 will be the charm....
Tuesday, August 25, 2009
First Night Didn't Go so Well
Well, I'm definitely more settled in and have personal effects up now. My new place is really nice and I think we will like it here. However, last night was one of the worst nights of sleep/dreaming we've had in a long time.
Our new apartment is a basement/mother-in-law style apartment in the basement of this family's house where I will be attending church while in this city. They've been nothing but gracious to me and are allowing me to live here for next to nothing. If I wasn't used to substituting random people and random situations into my nightmares, then I think I would feel guilty about last nights dreams on top of how awful the dreams made me feel. Luckily, I can seperate that this was just a dream and has no bearing on the people living upstairs.
This is the part where I talk about the dream. *May be triggering*
I dreamt the man of the household held me captive in my apartment. Except the apartment wasn't in the basement of their house. It was a cabin in the woods. And the man holding me captive was my landlord, but he didn't look like the man who lives upstairs in this house. He used me and abused me. I have pictures in my mind of him raping me that are so vivid, that if I hadn't been an adult in my dream and know for a fact nothing has happened to me as an adult, I would swear these were real memories resurfacing.
I was able to escape at some point. In my dream, I told my mother (something I never did as a child or would have done in the past) and they moved me out immediately promising to find me a safer place to live. This part of the dream was validating, but I remember feeling so traumatized by the time that I was rescued that it didn't feel it mattered.
I woke up a few times during the night but was never able to stop the dream. The dream either picked up where it left off or started over again. It's been a long time since we've had a traumatic dream that appeared to take place in the present. I was so drained this morning and so overwhelmed by all the feelings and images, I wasn't able to get out of bed until noon today. Thankfully, today was just a day of unpacking, so it didn't matter much.
Really praying tonight's sleep is better. If we start a pattern of nightmares at the beginning of sleeping in this new place, then it will never feel safe to lots of parts inside and we really need home to be a safe place.
Our new apartment is a basement/mother-in-law style apartment in the basement of this family's house where I will be attending church while in this city. They've been nothing but gracious to me and are allowing me to live here for next to nothing. If I wasn't used to substituting random people and random situations into my nightmares, then I think I would feel guilty about last nights dreams on top of how awful the dreams made me feel. Luckily, I can seperate that this was just a dream and has no bearing on the people living upstairs.
This is the part where I talk about the dream. *May be triggering*
I dreamt the man of the household held me captive in my apartment. Except the apartment wasn't in the basement of their house. It was a cabin in the woods. And the man holding me captive was my landlord, but he didn't look like the man who lives upstairs in this house. He used me and abused me. I have pictures in my mind of him raping me that are so vivid, that if I hadn't been an adult in my dream and know for a fact nothing has happened to me as an adult, I would swear these were real memories resurfacing.
I was able to escape at some point. In my dream, I told my mother (something I never did as a child or would have done in the past) and they moved me out immediately promising to find me a safer place to live. This part of the dream was validating, but I remember feeling so traumatized by the time that I was rescued that it didn't feel it mattered.
I woke up a few times during the night but was never able to stop the dream. The dream either picked up where it left off or started over again. It's been a long time since we've had a traumatic dream that appeared to take place in the present. I was so drained this morning and so overwhelmed by all the feelings and images, I wasn't able to get out of bed until noon today. Thankfully, today was just a day of unpacking, so it didn't matter much.
Really praying tonight's sleep is better. If we start a pattern of nightmares at the beginning of sleeping in this new place, then it will never feel safe to lots of parts inside and we really need home to be a safe place.
Monday, August 24, 2009
First Night in New Place
This is our first night in our new place. I got so distracted with other things last week, I can't remember if I mentioned that we were moving cities. It's only an hour away from where we were, and it's so we can start school full-time next week and be in the same city as our fiance' when he gets home in December, but a new bedroom, a new apartment means learning to feel safe here and make it our own again.
We're in a really safe neighborhood and we're in the basement apartment of a family who a friend of mine really trusts, so the safety shouldn't be too big of an issue. Making it our own will be a bit more challenging. The couple's oldest daughter lived down here for awhile before she got married this past summer. All of her photos are all over the bedroom. Most of the clothes in the closet are hers. The family didn't do a very good job of cleaning out their effects for me to make this space my own. However, they are letting me rent this place for an incredible price and it is really nice. I'm sure in time, we'll find ways to make it our own and put up our own pictures. Maybe we'll just take hers down and store them and put them back up when we move out next May. That's an idea....
Thankfully we're pretty tired tonight. We had therapy this afternoon and spent the evening unpacking boxes and trying to find places for our stuff. So, we should sleep pretty well tonight. Tomorrow will be more unpacking and a trip out on the town to find a Target and a few other essential stores we'll want to be able to find while we're here.
We're in a really safe neighborhood and we're in the basement apartment of a family who a friend of mine really trusts, so the safety shouldn't be too big of an issue. Making it our own will be a bit more challenging. The couple's oldest daughter lived down here for awhile before she got married this past summer. All of her photos are all over the bedroom. Most of the clothes in the closet are hers. The family didn't do a very good job of cleaning out their effects for me to make this space my own. However, they are letting me rent this place for an incredible price and it is really nice. I'm sure in time, we'll find ways to make it our own and put up our own pictures. Maybe we'll just take hers down and store them and put them back up when we move out next May. That's an idea....
Thankfully we're pretty tired tonight. We had therapy this afternoon and spent the evening unpacking boxes and trying to find places for our stuff. So, we should sleep pretty well tonight. Tomorrow will be more unpacking and a trip out on the town to find a Target and a few other essential stores we'll want to be able to find while we're here.
Tuesday, August 18, 2009
Appeal Denied!
Alas, my appeal to insurance company #1 was denied. I must say I'm not surprised. You think they'd have taken more than a day to make a decision after all of the paperwork we sent them. At least this time they picked a real reason. I don't consider it valid, b/c mental health coverage is bull crap these days and no reason they can give to not cover me is valid, but they did at least pick an accurate mental diagnosis from my medical record. Well I'm not sure if Prolonged PTSD really exists as a diagnosis, but I know PTSD does.
Here's my denial letter:
Dear Applicant:
Thank you for providing additional information to us regarding the decline of your application for Personal Health Coverage.
We have re-evaluated our original decision based on the information already available to us and the new information you provided. Unfortunately, we are unable to alter our original decision at this time. Your records document treatment for Prolonged Prosttraumatic Stress Disorder. This results in your continued decline for coverage. If you wish to be reconsidered you will need to submit your complete medical and behavioral health records for review.
Blah, blah, blah, HIPAA Crap, blah, blah, blah (my interpretation of the next paragraph)
Sincerely,
Individual Health Underwriting Department
Seriously??? Sincerely? Yeah sure. Whatever. Insurance company #2 accepted me, so they'll get my money for the next year. Insurance co #1's loss. Idiots. They weren't going to be paying my mental health coverage and my physical health is great, so they're basically missing out on free money. Their loss.
Here's my denial letter:
Dear Applicant:
Thank you for providing additional information to us regarding the decline of your application for Personal Health Coverage.
We have re-evaluated our original decision based on the information already available to us and the new information you provided. Unfortunately, we are unable to alter our original decision at this time. Your records document treatment for Prolonged Prosttraumatic Stress Disorder. This results in your continued decline for coverage. If you wish to be reconsidered you will need to submit your complete medical and behavioral health records for review.
Blah, blah, blah, HIPAA Crap, blah, blah, blah (my interpretation of the next paragraph)
Sincerely,
Individual Health Underwriting Department
Seriously??? Sincerely? Yeah sure. Whatever. Insurance company #2 accepted me, so they'll get my money for the next year. Insurance co #1's loss. Idiots. They weren't going to be paying my mental health coverage and my physical health is great, so they're basically missing out on free money. Their loss.
Monday, August 17, 2009
rough therapy session
So I got up the nerve to ask therapist to read the blog entry about Thursday night's bed wetting incident. It felt easier to us for her to already know the incident rather than have to try to tell her. At the same time, this meant that, of course, today's session focused on the incident, the triggers, and the memories behind it.
Wow! I totally got the wind knocked out of me by today's session. I had no clue about who had felt triggered, what the trigger was or any idea about the memories associated with it when I showed up for the session. Within the first five minutes a nine year old part was forward in tears apologizing and explaining how it was an automatic reaction to certain physical sensations and feelings. Apparently the dream we were having that night triggered her and her extreme fear triggered the physical response of wetting the bed.
With some coaxing, therapist was able to have the younger part share the memories related to this trigger response. Knowing the story behind the response, it does make perfect sense, and it explains other incidences throughout my life (not all wetting the bed) that I've never been able to understand why we responded the way we did..... and especially why I responded a certain way to something I thought I had no experience with. It's so weird. They're new memories to me and need to be processed, but they make pieces of my life make more sense. Memories like these are relieving b/c they fill in gaps and sooooooo painful because they continue to solidify our past, in addition to just being painful to look at, think about, and process.
Among all of us, I think our tears ran almost solid for about 4 hours tonight. It's been awhile since we've cried that hard and that long about something. I so wished my fiance' was around tonight so he could comfort me and make me feel safe, but at the same time I was so glad he was far away and couldn't see me like that. As much progress as we're making in self-esteem and trusting him, there's still a fear that the first time he really sees us struggling (even if it's just for a few hours), he's going to change his mind. Those that know me in real life, say this is an unfounded fear. I don't think I'll be able to shake it until I see how he really does respond, but at the same time I don't want to see it on the chance it's not what I want/need.
And this loops back into the ever present struggle of whether it's better to deal with things on your own knowing you can look people in the eyes b/c they don't know your dark secrets, or reaching out for help and support and risking being let down and/or embarrassed. I am learning that talking and not doing things alone really is easier and better, and that I don't give the people in my life enough credit for what they are capable of handling. At the same time, there's always that feeling that the next issue may be the one to push them over the edge.
I don't know. I feel like I'm rambling now. I really do use this blog like my personal journal rather than thinking about what I'm going to write and posting it in a succinct and to the point manner. *Sigh.* Bedtime.
Wow! I totally got the wind knocked out of me by today's session. I had no clue about who had felt triggered, what the trigger was or any idea about the memories associated with it when I showed up for the session. Within the first five minutes a nine year old part was forward in tears apologizing and explaining how it was an automatic reaction to certain physical sensations and feelings. Apparently the dream we were having that night triggered her and her extreme fear triggered the physical response of wetting the bed.
With some coaxing, therapist was able to have the younger part share the memories related to this trigger response. Knowing the story behind the response, it does make perfect sense, and it explains other incidences throughout my life (not all wetting the bed) that I've never been able to understand why we responded the way we did..... and especially why I responded a certain way to something I thought I had no experience with. It's so weird. They're new memories to me and need to be processed, but they make pieces of my life make more sense. Memories like these are relieving b/c they fill in gaps and sooooooo painful because they continue to solidify our past, in addition to just being painful to look at, think about, and process.
Among all of us, I think our tears ran almost solid for about 4 hours tonight. It's been awhile since we've cried that hard and that long about something. I so wished my fiance' was around tonight so he could comfort me and make me feel safe, but at the same time I was so glad he was far away and couldn't see me like that. As much progress as we're making in self-esteem and trusting him, there's still a fear that the first time he really sees us struggling (even if it's just for a few hours), he's going to change his mind. Those that know me in real life, say this is an unfounded fear. I don't think I'll be able to shake it until I see how he really does respond, but at the same time I don't want to see it on the chance it's not what I want/need.
And this loops back into the ever present struggle of whether it's better to deal with things on your own knowing you can look people in the eyes b/c they don't know your dark secrets, or reaching out for help and support and risking being let down and/or embarrassed. I am learning that talking and not doing things alone really is easier and better, and that I don't give the people in my life enough credit for what they are capable of handling. At the same time, there's always that feeling that the next issue may be the one to push them over the edge.
I don't know. I feel like I'm rambling now. I really do use this blog like my personal journal rather than thinking about what I'm going to write and posting it in a succinct and to the point manner. *Sigh.* Bedtime.
Friday, August 14, 2009
Embarrassed
So, I'm embarrassed about a situation last night to the point that we don't want to tell our therapist. We don't think she'll condemn us, but we don't know she can give us the validation we're looking for. Besides that, the body is 28, things like this shouldn't happen. I've even debated writing here. I'm anonymous to most of you but not all of you, so it still feels a risk posting here. However, I am so desperate for some understanding or validation or coping skill so I can make sure it doesn't happen again.
So, I wet the bed last night. Not just a little. The kind where I woke myself up and had to run to the restroom, then strip my bed, find towels to try and dry my mattress, and then clean everything today. We haven't wet the bed since we were a child. I don't remember exactly what I was dreaming about, but it wasn't a nightmare or memory. I'm vaguely having a childhood memory in bits and pieces that may have something to do with it. It's not a full memory yet, and I don't know whose it is yet. What I find odd, is usually when my body responds physically to a trigger when I'm sleeping, I'm actively having the dream too.
All I can think about today is how thankful I am that I was not sharing my bed with anyone last night. Also, I keep thinking that I'm getting married in 9 months. How embarrassing if this happens after I get married!?!??!?!??!?! I know I need to talk to therapist about this. Maybe we'll get the courage by Monday. I just don't really want to talk about this to anyone face to face. I feel sooooooo embarrassed.
I mean, seriously, does any other 28 year old wet the bed?
So, I wet the bed last night. Not just a little. The kind where I woke myself up and had to run to the restroom, then strip my bed, find towels to try and dry my mattress, and then clean everything today. We haven't wet the bed since we were a child. I don't remember exactly what I was dreaming about, but it wasn't a nightmare or memory. I'm vaguely having a childhood memory in bits and pieces that may have something to do with it. It's not a full memory yet, and I don't know whose it is yet. What I find odd, is usually when my body responds physically to a trigger when I'm sleeping, I'm actively having the dream too.
All I can think about today is how thankful I am that I was not sharing my bed with anyone last night. Also, I keep thinking that I'm getting married in 9 months. How embarrassing if this happens after I get married!?!??!?!??!?! I know I need to talk to therapist about this. Maybe we'll get the courage by Monday. I just don't really want to talk about this to anyone face to face. I feel sooooooo embarrassed.
I mean, seriously, does any other 28 year old wet the bed?
Wednesday, August 12, 2009
Upper hand now?
Today's update in this continuing insurance saga:
Insurance company #2 offered me an insurance plan today. :D The only bad part is it has a 50% price increase because of my medical records. It's still about half as much as if I had to pay for Cobra, but I'm pretty sure they won't cover any of my mental health. It's not the best plan, but it's very exciting to know I can get health insurance that I can afford even if it is about $100 more per month than I wanted to pay.
Also, my insurance broker submitted my appeal to insurance company #1 today. The hope is that they'll reconsider and if they accept me come back with a lower monthly payment than insurance company #2. I wonder if they both approve, if I can play them off of each other to get a cheaper rate? That would be awesome, but I hate to risk it and have both of them say, "fine, just go with the other company" and end up screwing myself over.
At least I might have the upper hand in this situation again rather than just begging and pleading that someone will offer me insurance coverage at any cost. :D
Insurance company #2 offered me an insurance plan today. :D The only bad part is it has a 50% price increase because of my medical records. It's still about half as much as if I had to pay for Cobra, but I'm pretty sure they won't cover any of my mental health. It's not the best plan, but it's very exciting to know I can get health insurance that I can afford even if it is about $100 more per month than I wanted to pay.
Also, my insurance broker submitted my appeal to insurance company #1 today. The hope is that they'll reconsider and if they accept me come back with a lower monthly payment than insurance company #2. I wonder if they both approve, if I can play them off of each other to get a cheaper rate? That would be awesome, but I hate to risk it and have both of them say, "fine, just go with the other company" and end up screwing myself over.
At least I might have the upper hand in this situation again rather than just begging and pleading that someone will offer me insurance coverage at any cost. :D
Tuesday, August 11, 2009
The appeal process
And the appeal process begins. My insurance broker has all of the necessary medical paperwork and my therapist sent him this letter to go along with the appeal today. I am thoroughly enjoying how passionate therapist has been about this appeal process. It has been very entertaining. It has also been very honoring and humbling. She has spent a lot of time over the last few days working for me to get me the coverage she says I deserve. I know I survived before I met therapist, but some day I really wonder how. Below is the letter she wrote my insurance company. Any identifying factors have been removed for confidentiality purposes, but I wanted to share her awesome words and all of her hard work on our behalf. :D The words in green are the ones I changed for confidentiality reasons.
Therapist Name, M.S.S.W., L.C.S.W.
Licensed Clinical Social Worker
Insurance Broker's name
Insurance Services, LLC
Address
Hunley, J. (2003). Cost-effectiveness and medical cost-offset considerations in psychological service provision. Canadian Psychology, 44 (1), 61-73. Retrieved August 11, 2009, from http://pharmacy.auburn.edu/pcs/mtms/LitSearch/Cost-Effectiveness%20and%20Medical%20 Cost-Offset%20Considerations%20in%20Psychological%20Service%20Provision.pdf.
Law, D.D., Crane, D.R., & Berge, J.M. (2003). The influence of individual, marital and family therapy on high utilizers of health care. Journal of Marital and Family Therapy, 29, (3), 353-363. Retrieved August 11, 2009, from http://russcrane.com/papers/MFT_and_Health _Care/2003_MFT_and_High_Utilizers.pdf.
Law, D. D. & Crane, D.R. (2000). Influence of Marriage and Family Therapy on Healthcare Utilization. Journal of Marriage and Family Therapy, 26 (3), 281-291. Retrieved August 11, 2009, from http://russcrane.com/papers/MFT_and_Health_Care/2008_Patterns_of_ Outpatient_Services.pdf.
Olfson, M., Sing, M., & Schlesinger, H.J. (1999). Mental health/medical care cost offsets: Opportunities for managed care. Health Affairs, 19 (2), 79-90. Retrieved August 10, 2009, from http://content.healthaffairs.org/cgi/reprint/18/2/79.
Bravehearts is in good physical health and has not excessively utilized medical healthcare services in general or to address any mental-health related issues. I expect that to continue, especially given that she has been and continues to be actively and consistently engaged in the treatment process, is compliant with all treatment recommendations and has a strong prognosis for long-term positive outcomes.
I respectfully request that you re-evaluate Bravehearts' application for insurance coverage giving consideration to the clarifications provided above regarding her toxicology report, the context in which the eating disorder diagnosis was applied and the research which supports my professional assessment that Bravehearts' mental health issues do not create a risk of higher than usual utilization of medical healthcare services.
Sincerely,
Therapist Name, MSSW, LCSW
Licensed Clinical Social Worker
Therapist Name, M.S.S.W., L.C.S.W.
Licensed Clinical Social Worker
Insurance Broker's name
Insurance Services, LLC
Address
City, State, Zip
Dear Insurance Broker,
I am writing per the request of my client, Bravehearts, to comment on the reasons given by Health Insurance Company #1 for denying her application for health insurance. One reason given referenced a positive toxicology report for benzodiazepine poisoning. A second reason referenced an eating disorder diagnosis. And a third reason referenced the opinion that individuals who have a mental health diagnosis and have received mental health treatment are likely to have a higher utilization of general medical services and thus incur higher healthcare costs.
1. The toxicology report (enclosed) dated 12/10/2007 very plainly indicates that the results were NEGATIVE for all substances listed, including benzodiazepines.
2. Bravehearts was admitted specifically to the Trauma Disorders Program at Hospital Name in February 2008, not the Eating Disorders Program. The discharge summary dated 03/20/08 included four Axis I diagnoses, the last of which was Eating Disorder NOS. The detailed summary explicitly states:
“… the patient stated that severe PTSD symptoms, attributed to a particular self-state, prevented her from eating during daylight hours. … Notably, the patient exhibited eating disordered behavior (refusal to eat anything before 6pm each day), but this was attributable to her efforts to avoid increased PTSD symptoms which were triggered by eating. Therefore, her eating disorder was also a focus of treatment in the context of managing her PTSD.”
The “eating disordered behavior” had to do with the time of day she ate, which as mentioned above was directly attributable to the PTSD symptoms. It did not involve any restrictions regarding quantity or nutritional quality of intake, or any type of purging behaviors – all of which are principal elements of a primary Eating Disorder diagnosis.
3. While some research indicates that individuals with mental health conditions often have a high utilization of other healthcare services, other research (see quote and additional references provided) indicates that individuals who show progress as a result of receiving mental health treatment have a lower utilization of other healthcare services.
“Cost offsets may be achieved in several ways. Specialty mental health treatment may prevent unnecessary medical care use, reduce future demands on medical resources, or simply substitute for mental health care delivered by primary care providers in instances when it is ineffective. Some mental disorders masquerade as general medical illnesses and lead to unnecessary use of medical care services. If accurate diagnosis leads to an appropriate refocusing of treatment on the underlying mental condition, it may reduce use of such unnecessary, and potentially harmful, medical services. Early and effective treatment of disorders such as alcohol and drug abuse may reduce medical complications and future medical costs. In still other cases, appropriate mental health care may reduce unnecessary medical spending by improving self-care and adherence to prescribed medical regimens (Olfsen, Sing & Schlesinger, 1999).”
The results of a metaanalysis conducted by Gabbard in 1999 revealed that “... eight (80%) of the 10 clinical trials with random treatment assignment and all eight (100%) of the studies in which treatment was not randomly assigned sugget that psychotherapy reduces a variety of costs. Combinig the studies, we can conclude that 88.9% of the relevant studies suggest a beneficial economic impact of psychotherapy (152).“
According to another metanalysis study (Hunley, 2003) “... psychological interventions also appear to have the potential to reduce health care costs, as successfully treated patients frequently reduce their utilization of other health care services. In some instances, the reduced cost to the health care system may actually be greater than the cost of the psychological service, thus resulting in a total cost offset to the system (14).“
REFERENCES
Crane, D.R., & Christenson, J.D. (2008). The Medical offset effect: Patterns in outpatient services reduction for high utilizers of health care. Contemporary Family Therapy, 30, (127-138). Retrieved August 10, 2009, from http://www.eftacim.org/doc_pdf/crane-christenson.pdf.
Gabbard, G. O., Lazar, S. G., Hornberger, J., & Spiegel, D. (1997). The Economic impact of psychotherapy: A review. American Journal of Psychiatry, 154(2), 147-155.Retrieved August 10, 2009, from http://ajp.psychiatryonline.org/cgi/reprint/154/2/147.pdf.
Holder, H. (1998). Cost benefits of substance abuse treatment: an overview of results from alcohol and drug abuse. Journal of Mental Health Policy and Economics, 1 (1), 23-29. Retrieved August 10, 2009, from http://www.icmpe.org/test1/journal/issues/v1i1/v1i1text04.pdf.
Hudson, C.G. (2008). The impact of managed care on the psychiatric offset effect. International Journal of Mental Health, 37 (1), 32-60. Retrieved August 11, 2009, from
http://mesharpe. metapress.com/media/7hxdajxwun7kq9jmet8l/contributions/y/0/7/0/y0704g1661216503.pdf.Dear Insurance Broker,
I am writing per the request of my client, Bravehearts, to comment on the reasons given by Health Insurance Company #1 for denying her application for health insurance. One reason given referenced a positive toxicology report for benzodiazepine poisoning. A second reason referenced an eating disorder diagnosis. And a third reason referenced the opinion that individuals who have a mental health diagnosis and have received mental health treatment are likely to have a higher utilization of general medical services and thus incur higher healthcare costs.
1. The toxicology report (enclosed) dated 12/10/2007 very plainly indicates that the results were NEGATIVE for all substances listed, including benzodiazepines.
2. Bravehearts was admitted specifically to the Trauma Disorders Program at Hospital Name in February 2008, not the Eating Disorders Program. The discharge summary dated 03/20/08 included four Axis I diagnoses, the last of which was Eating Disorder NOS. The detailed summary explicitly states:
“… the patient stated that severe PTSD symptoms, attributed to a particular self-state, prevented her from eating during daylight hours. … Notably, the patient exhibited eating disordered behavior (refusal to eat anything before 6pm each day), but this was attributable to her efforts to avoid increased PTSD symptoms which were triggered by eating. Therefore, her eating disorder was also a focus of treatment in the context of managing her PTSD.”
The “eating disordered behavior” had to do with the time of day she ate, which as mentioned above was directly attributable to the PTSD symptoms. It did not involve any restrictions regarding quantity or nutritional quality of intake, or any type of purging behaviors – all of which are principal elements of a primary Eating Disorder diagnosis.
3. While some research indicates that individuals with mental health conditions often have a high utilization of other healthcare services, other research (see quote and additional references provided) indicates that individuals who show progress as a result of receiving mental health treatment have a lower utilization of other healthcare services.
“Cost offsets may be achieved in several ways. Specialty mental health treatment may prevent unnecessary medical care use, reduce future demands on medical resources, or simply substitute for mental health care delivered by primary care providers in instances when it is ineffective. Some mental disorders masquerade as general medical illnesses and lead to unnecessary use of medical care services. If accurate diagnosis leads to an appropriate refocusing of treatment on the underlying mental condition, it may reduce use of such unnecessary, and potentially harmful, medical services. Early and effective treatment of disorders such as alcohol and drug abuse may reduce medical complications and future medical costs. In still other cases, appropriate mental health care may reduce unnecessary medical spending by improving self-care and adherence to prescribed medical regimens (Olfsen, Sing & Schlesinger, 1999).”
The results of a metaanalysis conducted by Gabbard in 1999 revealed that “... eight (80%) of the 10 clinical trials with random treatment assignment and all eight (100%) of the studies in which treatment was not randomly assigned sugget that psychotherapy reduces a variety of costs. Combinig the studies, we can conclude that 88.9% of the relevant studies suggest a beneficial economic impact of psychotherapy (152).“
According to another metanalysis study (Hunley, 2003) “... psychological interventions also appear to have the potential to reduce health care costs, as successfully treated patients frequently reduce their utilization of other health care services. In some instances, the reduced cost to the health care system may actually be greater than the cost of the psychological service, thus resulting in a total cost offset to the system (14).“
REFERENCES
Crane, D.R., & Christenson, J.D. (2008). The Medical offset effect: Patterns in outpatient services reduction for high utilizers of health care. Contemporary Family Therapy, 30, (127-138). Retrieved August 10, 2009, from http://www.eftacim.org/doc_pdf/crane-christenson.pdf.
Gabbard, G. O., Lazar, S. G., Hornberger, J., & Spiegel, D. (1997). The Economic impact of psychotherapy: A review. American Journal of Psychiatry, 154(2), 147-155.Retrieved August 10, 2009, from http://ajp.psychiatryonline.org/cgi/reprint/154/2/147.pdf.
Holder, H. (1998). Cost benefits of substance abuse treatment: an overview of results from alcohol and drug abuse. Journal of Mental Health Policy and Economics, 1 (1), 23-29. Retrieved August 10, 2009, from http://www.icmpe.org/test1/journal/issues/v1i1/v1i1text04.pdf.
Hudson, C.G. (2008). The impact of managed care on the psychiatric offset effect. International Journal of Mental Health, 37 (1), 32-60. Retrieved August 11, 2009, from
Hunley, J. (2003). Cost-effectiveness and medical cost-offset considerations in psychological service provision. Canadian Psychology, 44 (1), 61-73. Retrieved August 11, 2009, from http://pharmacy.auburn.edu/pcs/mtms/LitSearch/Cost-Effectiveness%20and%20Medical%20 Cost-Offset%20Considerations%20in%20Psychological%20Service%20Provision.pdf.
Law, D.D., Crane, D.R., & Berge, J.M. (2003). The influence of individual, marital and family therapy on high utilizers of health care. Journal of Marital and Family Therapy, 29, (3), 353-363. Retrieved August 11, 2009, from http://russcrane.com/papers/MFT_and_Health _Care/2003_MFT_and_High_Utilizers.pdf.
Law, D. D. & Crane, D.R. (2000). Influence of Marriage and Family Therapy on Healthcare Utilization. Journal of Marriage and Family Therapy, 26 (3), 281-291. Retrieved August 11, 2009, from http://russcrane.com/papers/MFT_and_Health_Care/2008_Patterns_of_ Outpatient_Services.pdf.
Olfson, M., Sing, M., & Schlesinger, H.J. (1999). Mental health/medical care cost offsets: Opportunities for managed care. Health Affairs, 19 (2), 79-90. Retrieved August 10, 2009, from http://content.healthaffairs.org/cgi/reprint/18/2/79.
Bravehearts is in good physical health and has not excessively utilized medical healthcare services in general or to address any mental-health related issues. I expect that to continue, especially given that she has been and continues to be actively and consistently engaged in the treatment process, is compliant with all treatment recommendations and has a strong prognosis for long-term positive outcomes.
I respectfully request that you re-evaluate Bravehearts' application for insurance coverage giving consideration to the clarifications provided above regarding her toxicology report, the context in which the eating disorder diagnosis was applied and the research which supports my professional assessment that Bravehearts' mental health issues do not create a risk of higher than usual utilization of medical healthcare services.
Sincerely,
Therapist Name, MSSW, LCSW
Licensed Clinical Social Worker
Saturday, August 8, 2009
Round 2 begins...
So my insurance broker, my therapist, and I have decided to appeal the denial insurance company number 1 gave me. The reasons they listed for denying me coverage are bogus. To draw the conclusions they did, they would have had to twist my medical records from an ER visit and deny me coverage for an ED NOS dx I got a few years ago. From everything I know, private insurance companies won't acknowledge or pay for NOS diagnoses and on top of that it was the last in my list of Axis I diagnoses. So, theoretically, they can't deny me coverage for a disorder they don't acknowledge as a disorder...... Nevermind the fact I don't really have an eating disorder. It was all related to some major PTSD symptoms I was dealing with. Once those issues were addressed, the eating fixed itself, and hasn't been much of an issue in close to 18 months.
In the meantime, I'm applying to a couple other individual insurance plans with different companies. Who knows if they'll accept me. I'm not so hopeful, but at least I don't feel without option yet.
On that note, I don't expect the first insurance company to ever offer me insurance. It seems having current diagnoses of PTSD and DID will be enough for them to deny me coverage - nevermind the fact that I'm not asking for mental health coverage, just physical health coverage. Mostly, it's more if they're going to deny me coverage, then they need to have valid reasons. So, creating more work for them and being a pain in their side for a short period of time feels like some sort of weird justice on my part.
I know. It's taking my frustrations out on the wrong people and not on the real root of the problem. Since that is impossible, this seems the best we can do for now.
In the meantime, I'm applying to a couple other individual insurance plans with different companies. Who knows if they'll accept me. I'm not so hopeful, but at least I don't feel without option yet.
On that note, I don't expect the first insurance company to ever offer me insurance. It seems having current diagnoses of PTSD and DID will be enough for them to deny me coverage - nevermind the fact that I'm not asking for mental health coverage, just physical health coverage. Mostly, it's more if they're going to deny me coverage, then they need to have valid reasons. So, creating more work for them and being a pain in their side for a short period of time feels like some sort of weird justice on my part.
I know. It's taking my frustrations out on the wrong people and not on the real root of the problem. Since that is impossible, this seems the best we can do for now.
Thursday, August 6, 2009
Round 1: Health Insurance =1, Bravehearts =0
And the health insurance saga continues. Even waiving my HIPAA rights and saying I will pay out of pocket for my counseling and psych meds, was not enough for my current group health agency to switch me to an individual plan in September. Even though, all I'm asking for is coverage for when I see my primary care if I get sick or if I need to go to the hospital for an injury, apparently, I am still too great of a risk. Apparently, perfect physical health doesn't mean much if your mental health isn't perfect as well...... even if they're not going to cover it.
Applied to another insurance company today. I want to be optimistic, but we're already feeling so defeated. I'm sure our feelings are a bit of an overkill, but it's where we are. Thoughts of : What's the point? Why are we working so hard on healing? Apparently it doesn't make a difference. 18 months of no hospitilizations and the continuation of lowering and stopping meds means nothing to any managed care. Then I think, why should it? To them I'm just a number, a risk, a peon. If I thought President Obama's healthplan would actually help more than hurt, I'd jump on that bandwagon. That doesn't really matter though. If that goes through, by the time it becomes legislation, I should be married and can get on my husband's health insurance.
I also keep telling myself, there are ways to get insurance. Problem is that it is so expensive. I can get COBRA insurance from my current job, but it is over $500 a month. Did I mention my graduate assistant stipend is $700 a month? I could get the university's health insurance, but it's crappy, expensive, and will invoke 12-month waiting periods for pre-existing conditions. Plus, I have to go to their clinic before I can get referred to anyone else, and they have stupid office hours like 8am-4pm. What happens if I get sick at 5:30pm?
I truly do think that God will work everything out by September, but it doesn't make the defeatist attitude and emotions I feel right now go away. I really hope as we continue to heal, this feeling will lessen when we face obstacles related to our past, specifically ones that we're moving on from until some managed care system throws it up in our face.
I guess it's that 3 steps forward, 2 steps back kind of thing...
Applied to another insurance company today. I want to be optimistic, but we're already feeling so defeated. I'm sure our feelings are a bit of an overkill, but it's where we are. Thoughts of : What's the point? Why are we working so hard on healing? Apparently it doesn't make a difference. 18 months of no hospitilizations and the continuation of lowering and stopping meds means nothing to any managed care. Then I think, why should it? To them I'm just a number, a risk, a peon. If I thought President Obama's healthplan would actually help more than hurt, I'd jump on that bandwagon. That doesn't really matter though. If that goes through, by the time it becomes legislation, I should be married and can get on my husband's health insurance.
I also keep telling myself, there are ways to get insurance. Problem is that it is so expensive. I can get COBRA insurance from my current job, but it is over $500 a month. Did I mention my graduate assistant stipend is $700 a month? I could get the university's health insurance, but it's crappy, expensive, and will invoke 12-month waiting periods for pre-existing conditions. Plus, I have to go to their clinic before I can get referred to anyone else, and they have stupid office hours like 8am-4pm. What happens if I get sick at 5:30pm?
I truly do think that God will work everything out by September, but it doesn't make the defeatist attitude and emotions I feel right now go away. I really hope as we continue to heal, this feeling will lessen when we face obstacles related to our past, specifically ones that we're moving on from until some managed care system throws it up in our face.
I guess it's that 3 steps forward, 2 steps back kind of thing...
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