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.

Still kicking

Just wanted to take a few minutes to post that I'm still here putting one foot in front of the other. Things have calmed down a little bit from last week, but I'm still dealing with very raw emotions, and feelings of vulnerability and instability that are higher than normal for me.

I've gotten to see hubby more this week, and that's been helpful. Still fighting with the insurance company to pay for therapy and hubby is still leaving for 3 weeks next Tuesday for training, but we have fun weekend plans, so I'm trying to stay focused on that.

We admitted to therapist yesterday that we don't "feel" safe right now. Not unsafe in the sense that we're afraid we'll hurt ourselves, but no place feels like a safe haven right now. I put "feel" in quotation marks because my rational mind knows that we're not safe. My therapist calls this "classic" PTSD. I don't know whether to be reassured or demoralized by that. I guess it doesn't really matter. I keep reassuring us that we are safe, but it doesn't seem to lessen the feelings. At least for the moment they're not too overwhelming. I know parts of me are feeling desperate though b/c they're using the fact that my weight is about 5 lbs. higher than what my optimum weight is as an excuse to restrict eating and over-exercise. My mind knows these things are bad for me and can remember that, at least for me, there is a direct correlation in getting enough nutrients and my depression levels. However, that rationality and knowledge is NOT as strong as the desires to act on these feelings and impulses. The only thing keeping this relatively under control right now is sheer will power and the desire to not get back into a really bad place.

Last night I awoke in a panicked stated with my husband asking me if I was okay. I have no idea what I was dreaming about. He left before I got up this morning, so I look forward to getting his take on things tonight.

On one hand, I still feel like we have a good grip on things and with therapist's help, this can stay very manageable (even though it won't be easy)and will even improve with time. On the other hand, I find myself praying that God can just help me stave off a total meltdown until after the first of the year. Then I can finish my internship and graduate with another blasted graduate degree that I may never use, and possibly see husband off on deployment without him having to see me at my lowest where no part of me rational.

All I know for sure right now is that I have control over my choices today, and what I need to focus on is what I can do to make smart, healthy choices right now. *Sigh*

It really sucks being back in one-day-at-a-time modality.

Hubby's coming home today!!

Just wanted to write a quick post to say hi and that I'm hanging in there. Insurance is still up in the air about covering T, but I'm choosing to be thankful that it's still up in the air. Last week, I thought the book was closed on the topic of insurance paying, but now there's a slight chance again we can work things out. *Fingers crossed!!!*

Hubby's coming home from a month long training today! I'm so excited!! I've missed him so much!!! But that might mean it's a few days before I get to blog again. I want to spend time with him to make up for the past month and with both of us working right now, my blog might take a hit for a week or so. Once we're back into a routine, I hope to start blogging again. I find I miss it when I don't blog for awhile, but lately finding a time to blog has been challenging as well.

Anyways, I'm around. Plugging along, and making myself still work towards more complete healing. Thanks for keeping up with me. It really means more than I can say!

Circles in my Head

The past few days I feel like my head keeps getting caught in this circular thinking that results in a rollercoaster of emotions riding through my stomach and streaming down my face. Nothing that horrible has happened, yet at moments I feel like my life has come to a stop and the world is ending.

I recognize that these are triggered feelings based on current frustrating events. In therapy on Friday and today, I was able to talk about what I was feeling and identify what about the situation felt so triggering. It all makes sense, but understanding why doesn't make me feel any better.

As of Friday, my insurance denied to pay for my therapy. Therapist is 45 minutes too far South so she is considered out of network. There is still more than one option to work out ways I can continue to see therapist and it be affordable, so the majority of my feelings don't revolve around fear of losing therapist. My feelings start by being ticked at insurance company because they won't pay for something I need and deserve. Then I get pissed at Him for hurting us in the first place and getting away scott-free while we spend thousands of dollars in therapy to try to get our life back. Then I get pissed at husband b/c his job has had him away for 3 weeks and he'll be away for another week, and I've had virtually no contact with him, so I can't talk to him about this, my feelings, finances, etc. Then I get pissed that I still need therapy and is it even worth all of the hassle? Then I'm pissed at the whole world including myself. All of this leaves me wanting to crawl under a rock and never come out... to lie down and quit trying...

Then I calm down. I realize this issue with insurance is not the end of the world. I step back and look at how many good things I still have in my life and how blessed I am. I think about how I've walked through much harder things and come out just fine. I remember that God is in control and while he never promised me an easy road on this planet, He did promise me that I will overcome because of Him. I am convicted that lying down and giving up at this point is not an option. I've come too far and I still have further to go. So, I pick myself up. Go to my internship. Have dinner with friends and live. I'm currently sitting with a low level of depression and a deep level of sadness all of the time, but it is not debilitating.

Then, one little thing happens and the overwhelming feelings and thoughts start up again, everything blows up again, and I'm back to wishing I could go to sleep forever. I stick it out, calm down, think clearly again and get productive for a bit.

This is my cycle the past few days (minus the weekend when I just dissociated and contained all of this b/c you can't do anything about insurance over the weekend). I don't know how many more days this will be my cycle. It totally sucks!!!!! But I am sooooooooooo thankful I am cycling and not just staying in the difficult place.

This too shall pass. I just gotta keep myself from doing anything irrational during the rough spots and make my big decisions during times when I'm in the space to make big decisions responsibly.

Healing is a bear....

Recovering

Well, I'm finally starting to get over this cold. Whew! 100 degree temperatures and starting my internship this week is not a good combination when your body decides to get a cold. I'm physically exhausted this afternoon, but feeling much more emotionally stable than yesterday.

I thought once I got on to husband's insurance, things would be a lot easier in getting sessions approved to see therapist and I could stop paying out of pocket to see her. Boy, was I wrong! Apparently, I have an unlimited amount of sessions (which is cool) but they don't want to pay for me to see therapist b/c even though she takes my insurance she's technically out of network b/c I'm considered in the North network and she's considered to be in the South network. Her office is 40 miles from where I live. There is NO DID/PTSD therapist closer than that. Plus, I don't know any details, but I know therapist sees other clients who have my exact insurance so I know they can make this approval for me.

Normally, I'm used to the insurance run around, and I'm up for the challenge, but yesterday I was just over it. I was tired of fighting them, tired of my drama, and spent most of my session telling therapist while she should be tired of me too. Thankfully this was just my overreacting and irrationality and she is not tired of me and found it ridiculous that I would even suggest such.

In all honesty, I think the thing that hit me the hardest was the realization of how much I still need therapy and still need therapist. Many days I'm functioning well and even find myself wondering if I still need to see therapist twice a week and if I'm using the time wisely. I am aware and still acknowledge all of the progress we've made to move out of crisis/stabilization stage into a real working/healing life productive stage. But I guess sometimes I want to think this stage means I need less help or it will be less difficult. In reality, it's just difficult in a different way. 99% of the time it's a very manageable place to be in, but then I still have days like yesterday where it feels like the whole world is ending, and I can't do things one more day. The positive side is that typically I can sleep off the "world is ending" feeling and pick up and go on with life the next day. That's a HUGE difference and positive step forward that we've taken.

Healing is still baby steps.... I just gotta remember that to keep frustration levels down.

On a very positive note. I got to hear from husband today for the first time in 4 days!! Only 2 1/2 more weeks and he'll be home again. I never knew I could miss him this much. I'm going to consider that a very good thing that I am missing him. :)

To laugh or cry hysterically?

Yes, that is the type of day I've had today, and why I'm just now blogging at 12:01am. Just because I'm now finding my day rather hysterical now that it's over I'm going to share. Thank you for indulging me.

*Oh, before I go futher. There is mention of women's health issues and possible treatments, so proceed with caution if that is a concern for you.*

So, fiancee went with me to my mother's family's Christmas yesterday b/c his flight to Maine was cancelled b/c of snow in Newark, NJ. We were able to get him a flight out early this morning, but rather than leaving him all alone where we live, I drug him with me to my grandmother's house to meet all of my aunts, uncles, and cousins. He's never met my mom's family. It was rather entertaining.

Anyways, we had to get up at 5am today to get back to the airport he was flying out of in time for fiancee to catch his flight to ME. (He's spending Christmas there and meeting me and my family on Dec. 26 for a ski trip) So, as you may or may not know, I'm NOT a morning person and accidentally took my sleepy meds (Klonopin) this morning instead of my anti-depressant (Prozac). That should have been my sign to crawl back in bed and stay all day. I had to ask fiancee to drive to the airport b/c I was already glossy-eyed. He got a good laugh out of it.

After I dropped him off at the airport, I went to American Laser Center (my last splurge on myself before I quit my job was to purchase laser hair removal for my underarms - I used a coupon I got from a Women's Show and some money I'd been saving as "splurge money") for a treatment. Well, their coolant machine that goes along with the laser was broken. They said it might hurt more, but it wouldn't burn me. Riiiiight.... I don't think I've ever screamed in a doctors office before and I now have one nicely red, tender underarm. :P I said I'd come back when they fix the cooling machine.

From there I saw therapist, and it was probably the least stressful portion of my day. Too bad i couldn't have seen her tonight when I really had stuff to talk about.

After therapist, I went to my PCP, I've had a lingering women's issue(gotta love antibiotics for that) for over a month that I want gone before I start my travels on Sunday. Lucky for me they could work me in for today, bad for me, I have the worst yeast infection my doctors ever seen. I have to take a diflucan everyday for 3 days and then douche on Thursday if it's not better. Anyone ever douched??? I'm really not wanting to figure out what that's like. From there I went to the pharmacy where I was informed that my insurance will not pay for my diflucan Rx because I already had one filled this month.. Well, duh, I've been fighting this infection since the beginning of November!!!! Grrrr. Individual insurance stinks majorly!!!! But what can I do? I need the meds.

From there I finally make it back home and started a load of laundry b/c my plan tonight was to pack and clean my apartment since the family who owns the house that my apartment is in will be using my bed for a couple of their married children while I'm away. About 10 minutes after I started the washer, I went into the kitchen to fix some dinner. The kitchen floor was covered in water. The dishwasher wasn't running so I was confused. Stepping back out into the living room, I noticed the carpet in front of both bathroom doors was soaked. Running to the bathroom I saw standing water covering the entire bathroom floor about an inch thick. Yes, the washer broke. Apparently it no longer fills right and it somehow managed to overflow and gush water out the bottom of the washing machine. I wonder what I looked like splashing through the water to the washer to turn it off and turn the water off at the valve and then scrounging around trying to pick things up off the floor that didn't need to get wet (like my hair dryer and flat iron. I think the hair dryer is a loss). The family wasn't home, and towels made no dent in soaking up the water, so I called Mr. homeowner. He was out at the hospital visiting a church member, but he sent a neighbor over who was a plumber and he brought his shop vac and soaked up all the water. Then the carpet cleaner guys came and soaked the water out of the carpet, sprayed some anti-mildew stuff, and set up two huge fans and a dehumidifier in my apt. It's like a VERY LOUD white noise machine.

Now I sit here on my bed with suitcases packed for my trip. I have no idea what is in them. Hopefully stuff I'll want to wear. At this point, my day sounds rather comical, but I shed several tears through the course of the day as well. Now I am praying Murphy's law will not strike 2 days in a row.

If I'm going to draw a therapeutic note from all of this, I must say we are proud of ourselves for handling everything in stride and never feeling tempted to self-injure or anything else unhealthy........ and even finding a sense of humor about part of it.

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

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.

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...