Jillann, I'm so sorry about what's happening with the insurance. It's horrible that they are interfering in your treatment like this. I know it's hard, but please try to fight back against the belief that you have done something wrong here. You have done exactly the right thing in reaching out for care and you DO deserve care and help. The insurance company is clearly in the wrong on what is good for someone in your situation - I hope things turn around.

(((Jillian))) I agree with Jones. I know it's so easy to internalize insurance problems (being treated badly by an insurance company, having treatment denied, etc.) as a reflection on you, but it's really only a reflection on corporate culture that will minimize payouts to maximize profits.

It sounds like they've done some sort of utilization review process to determine how much treatment you need or what type? However, I find it questionable that they would say you don't need the treatment while simultaneously encouraging you to go through an in-network doctor. What sort of therapy are they labeling your T as doing that they don't think it will help with your diagnoses? From what I understand, a lot of insurance companies show preference for treatment plans that are short-term.

This is a triggering subject, because my insurance company is doing the same thing, except instead of with denying me treatment, they are basically making it such that the rates they'll say are "allowable" for my out-of-network T are far below what they're paying in-network Ts, so most of it won't count toward my deductible or maximum. They even repeatedly quoted higher numbers, then decided on these lower ones, which are basically the lowest of several ways they are allowed to calculate per my plan agreement (despite saying in writing they would give me the highest of them). Anyway, I keep feeling like there is something wrong with me for being treated this way, and for needing so much therapy that they basically are penalizing my rates for how sick I am. But, it's all on them and not me, in the end, the way they treat their customers.

Has your insurance had any communication with your T directly? I'm wondering what they based this decision on...because it doesn't make any sense. Here are some possible ways to follow up:

1. Have your T call them and obtain a single case agreement to act in network for just you. If she does this, they can negotiate a rate with her and maybe be willing to let you continue, as they'd have a greater understanding of your treatment plan.

2. File an appeal with your state's department of insurance. These appeals can take a long time to process, but perhaps your T would be willing to see you temporarily while you wait for the answer.

3. Look at your plan documents carefully and see what is involved in their utilization review or other denial of coverage clauses. Make sure that whatever they are doing is following what the plan has documented. Demand a thorough explanation of why this treatment is inappropriate for your diagnoses. If this is a plan governed by ERISA (many are), they have to answer any question you have about claims/denials of service/etc. within 30 days.

I'm sorry this is so painful and stressful. I'm in the same position where my insurance's treatment of me has been close to resulting in hospitalization bills when they could just pay him the usual and customary that they pay other Ts and I would be more than happy to foot the higher coinsurance. But, since they know we'd hit our maximum, they won't do that. They see me as a liability, rather than a human being. Even representatives in their own company act indignant when they first hear how we are being treated (we had one not believe us about them still changing the quotes manually to lower amounts and say, "That has to be wrong--we're a good company who takes care of its customers. I'm going to look into this and get it fixed for you," only to come back sheepishly and admit there was nothing they could do to help. We've actually had our ERISA request for information/justification on the rates denied since March, and since June, they continually skirt the issue by responding to the state's letters with only general intentions, "We won't be making any changes to their claims," rather than the specific documents we've requested...but because they respond in 30 days, then the state has to ask more specifically, they don't break the law, I guess?

Anyway, sorry if a lot of my own stuff leaked in here. The point was not to share my story as much as to show you that you being treated this way really has nothing to do with you. It has to do with an industry or company that cares more about profit than service. Sadly, that seems to be more and more the status quo...though maybe it's always been that way.

((((Jillian))) Sorry you're going through all this.

(((Jillan))))

I am completely lost in insurances questions (I don't have one because I am abroad, so I basically am lucky my T has a good sliding scale) so I just wanted to tell you that you are worth being cared for and that the situation is definitely not your fault. You were and are very right to reach for help, and the system is wrong in denying you this.
You deserve treatment, and care. I hope you can hear some of this and that things get better.

Thank you all for your kind responses. This whole situation has caused me to have a significant setback. When I talked with T on Tuesday and emailed her that night I told her about theSU. She told me to call my P the next day. They have upped my AD med for now.

I have real issues with anger. I cannot acknowledge those feeling within me and certainly not express them. She was trying to get me to Tuesday but it sends me into a suicidal tailspin. I turn it all inward on myself. I don't know how to do anything else.

Jones- Thank you so much for responding. I kept telling T it feels like there is a third person in the room with us. Someone who has never met me but is deciding what is best for me. Thanks for reassuring me I'm doing the right thing reaching out.

Yaku - Your reply was so affirming. I am not the only person they(insurance co's) are persecuting. Sometimes it helps to have that perspective. It could be so much worse. They are denying coverage because they believe she is not following best practices. According to them best practices are CBT with a treatment plan with specific, measureable, symptom focused goals and means to measure progress towards the goals." Apparently, my T spoke with them before this and told them she was using transactional analysis and redecision therapy. They didn't like those two things. T says that even if she says she is doing CBT they will only authorize a few visits. She said this is a typical manouver to end coverage. They want it spelled out. It will take 10 sessions to cure this patient. They also don't believe I need to be going to therapy twice a week. In the beginning I definately needed the twice a week support. Now I can probably move to once a week but I like going twice. I will have to go to once a week with no insurance coverage.

Contacting the state insurance commisioner is an awesome idea. Even if I don't file anything with them they should have some ideas to help me support my final appeal with the insurance company. I can make one more appeal that they will have an independent outside source evaluate. (They get to pick the independent source hmmmmmm.) I want to make sure it is as supported as I can make it.

Dear About - how sweet of you. I have this terrible self-anhilation thing that I do when faced with strong emotion. I think you may have some understanding of this too . Thanks so much for reaffirming that I deserve care.

SP - Thank You so much for your support. I turn all bad feelings in on myself. It makes living in my head so sad and lonely sometimes. I can think with my rational brain that these things aren't true but there is still that voice in my head screaming at me saying "you don't deserve to be treated well" and many more ugly things I won't post here. I will try to hang on to the belief that I am deserving.

Jillann

quote:

I can make one more appeal that they will have an independent outside source evaluate. (They get to pick the independent source hmmmmmm.) I want to make sure it is as supported as I can make it.

I have worked a lot with ins companies due to my profession - altho primarily with the medical aspect.
Request any and all info about how they would not offer continuation of coverage and the info you would need to support coverage. Get details and get them in writing.
Your T may also have to play around with diagnosis' to find out which one of yours would provide the best coverage.
Ins co HATE paying out particularly for trauma due to extended lengths of treatment and they will look at any and all reasons not to pay.
Additionally when you are sent for that independent eval make sure that the professional is a specialist in your specific diagnosis. Research him/her. If not, request someone different. and if they are, prior to your appt find out how they typically treat their own patients in this area & their lengths of treatment (usual & customary)- and if they are smart hopefully they will tell you every case is unique...therefore if there is a discrepancy in your findings and how they treat clients you can utilize that in another appeal if need be. Oh also (sorry so long!) see if they are "locked into" only 1 form of treatment...for example, ONLY use CBT and have closed their doors to other methods. these professionals tend to work for the ins co and not so much their patients which is why I avoid Ts that sing praises of the "currents trends" of therapy.