my experience with mental health coverage

If you’re living in the United States you had to have been living under a rock not to have heard at least a little of the health care debate over these past few weeks and the ensuing shut down of the government. I’ve stayed out of the facebook comments, the name-calling, the blaming etc. I really dislike those posts. I hate the hate that they breed. I don’t understand it. But what I do understand is how insurance has effected my life. And this is what I want to share with you.

Currently I am on my parent’s insurance, which I will remain on until 26 years of age. This extended age period is due to Obama-Care and is one of the few points both political parties agree on. Without this extended age I would be off my parents insurance which would be terrifying and leave me with little to no coverage (at least before the Insurance marketplace opened up this month). Even with my parents insurance I have experienced first hand the problems with our health system.

Mental health is misunderstood. I think that is clear to anyone who has been in the mental health system.  In 2008, The Health Parity and  Addiction Equality Act added onto the Mental Health Parity Act of 1996. The 2008 act:

 mandates that insurers define and make available specific criteria for medical necessity when it comes to mental health and substance abuse disorder benefits. In addition, MHPAEA also requires that insurers provide specific information and reasons in the event that reimbursement or payment for treatment is denied.

Okay, so this gave some required coverage to mental health. For me it came none too soon. I was hospitalized in September 2009. Less than a year from when this act was passed. Without it I never would have been able to have received treatment including outpatient therapy visits. However, even with this coverage what I needed was still not given to me. The insurance is still in control and even when my doctors advocated for me till they were blue in the face my insurance always cut out before I was ready or stable. Yes, they provided their specific reasons they denied but quite honestly they were bullshit. How can an insurance company claim to know more than my doctors? How can they who have never met me rule that I was in no danger of suicide, self-harm or relapse? How can an insurance claim to know my ideal weight or know what vitals are stable for me? And how can they know what exactly how my PTSD effects on a daily basis? They can’t. Yet every time I have been in some sort of treatment the insurance company does claim to know these things. And according to the law that’s quite alright as long as they provide proper documentation of why they are denying me further coverage.

In addition, my insurance doesn’t over me complete benefits. I have inpatient benefits meaning I can be hospitalized till I am medically stable but have no residential benefits. Residential is a level of care that provides a transition from inpatient to daily life. It is imperative in eating disorder treatment. It allows time for more therapy instead of just nutrition and weight gain. Residential allows the real “meat of therapy” to begin which can’t until nutrition is stabilized. By just leaving me hospitalized until I have gained some arbitrary number of pounds does nothing to aid in my recovery.

I am so blessed that my parents were able to pay out of pocket for residential treatment at CFC. But it came at a high cost to my family. Without this extra time I would not be able to be in recovery today. However, the insurance did not see it that way. They gave me two weeks. The center said I needed five and a half months. And over those five and half months I was placed on suicide watch multiple times. What would have happened to me if insurance had had to control my care? I truly do not know.

It doesn’t stop there. But to go further would get more into the politics than I want to and I’ve probably already delved far enough into that. Simply put – my experience with insurance has been one that teaches me that they care little for my health and more for their own profit. They skirt the laws and do the bare minimum. I’ve managed to survive in the system because I have a family that can help me with and that has some resources.   And honestly, I have one of the good policies. My mother has become a pro at navigating the insurance system and I’m lucky my first treatment center  did everything in their power to get me covered for as long as possible.

I don’t know what the answer to the problem of insurance is but to say there is no problem is not correct and is closing your eyes to the experiences of others. Without adequate (actually more than average, I need good mental health coverage) I will have no quality of life. I survive now because of a somewhat decent policies that I can benefit from until I’m 26 but after that? I face a future that before October 1st of this year was very scary. Now it seems somewhat less so.

Advertisements

1 Comment

Filed under depression, Independence, PTSD, Recovery, social change, society

One response to “my experience with mental health coverage

  1. My insurance never covered residential either. If CFC hadn’t offered the option to bill as day programme and then my family make up the (still not inexpensive) difference, I would have been kicked out of treatment eight days in to my last stay. In eight days, I hadn’t even started to put on enough weight to get me out of the “anorexic” category, but my vitals were fine, so yay! Go home!

    I’m glad your family was able to fund your treatment when your insurance wouldn’t. You are absolutely worth every dime they spent.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s