Wednesday, March 9, 2011

Insurance Co - Win, Patient - Lose

After a 9 month of petitions, correspondence, phone calls, e-mails, faxes, and waiting, my insurance company finally responded to my request for them to cover Therapist. Well, they're response is to not respond. Therapist finally got to talk to someone yesterday afternoon who gave her a direct, indirect answer.

See, my government health insurance divides the US by regions. When I moved to live in the same city as husband (even though I'm still in the same state), I was considered (by my insurance) to have changed regions. Now I live 10 miles outside of the region that Therapist is covered by. I am 40 miles away from Therapist, but if I lived 10 miles further South, they would allow me to see her and cover me. Now, it's taken 9 months to get this much information from them. The only reason we know this much is because Therapist continued to contact them b/c they were not responding to any of our submissions - either from her or from my PCP. When Therapist talked to them yesterday, she was told that they would never have contacted her or me or ever sent me a denial letter. Apparently my request is just automatically voided because I live in a different region that she practices in. I can't even get a denial letter. And we wouldn't have gotten any explanation if therapist hadn't been so persistent. I now know that for them to approve her, I will have to get written documentation from every provider in my region saying they can't or won't treat me. So, if someone 5 hours away (but in my region) agrees, I can drive 5 hours to therapy and they'll pay, but they won't pay if I drive 40 minutes in the 'wrong' direction to see Therapist who I've been with almost 5 years.

What pisses me off more than anything, isn't that they won't cover me (and that pisses me off A LOT). It pisses me off that for 9 months we haven't been able to get a direct answer out of anyone, and they think an acceptable answer is no response at all. Just ignore the request and hope I give up eventually? See, if they give me a denial letter, I have the right to appeal and submit paperwork to present my case. But if they don't respond at all, then I can't appeal and they don't have to grant coverage either. Glad to know the government is really looking out for the mental health of deployed soldiers' families like they claim to be...

Maybe government health care is more affordable. I can go to the doctor whenever I need to and not worry about cost. I do appreciate that. However, I didn't get to choose my doctor - any of my doctors for that matter. And when I really need specific help from a specific provider that my insurance recognizes in another region, I'm not even given a chance to present my case. Heck, the people reviewing my case probably don't even know what DID is, so how are they gonna understand the importance of working with a therapist that we trust?

I think I need to stop for now. I'm liable to post some not nice things that I'll wish I hadn't later. I'm feeling bitter about a lot of so called support I'm supposed to be getting while my husband is risking his life to keep our country safe that I'm not seeing, and this is just kind of the straw that broke the camel's back.

I don't regret the life my husband and I have chosen. I am so proud of him for what he does. It's just frustrating to hear the government say they're gonna cut you a break, and instead feel you're being treated like a number and that money is more important to them than me. It'd be easier if I was never promised anything. I wouldn't know any different.

I just think this whole thing is stupid. If I'd gotten this answer back in August, I'd have adjusted and budgeted and wouldn't be in huge debt to therapist right now. Therapist is cool about the money I owe her. I can back pay her as I'm able, but if either of us had known this would be the end result, we'd have made other provisions a lot sooner.

It makes me a little sick right now looking at my insurance card. In big letters across the top it says, "The World's Best Health Care for the World's Best Military." Forgive me if I don't agree with their statement about being the world's best health care right now.

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