Denied Weekly Sessions

[lostforgottensoul]

My health insurence has denied weekly vists to my therapist and says I "don't meet the minimium requirements. That my anxiety has improved and I am doing better at work. Member may use peer and/or community supports". So work encompasses all of my issues? And community support? Peer support? Unless they are speaking of this site, I can't be in a group of people. I can't be around people at all.

They are taking me down from weekly visits to every other week visits.

United Behavoral Health has a therapist that works for them. Many actually. My plan is unlimited. That means nothing. Every year they must "re-up" to keep me covered. Why I need to keep seeing a therapist weekly. Weekly was my therapist's suggestion. But as we went along, I also saw that necessary.

Anyway, every year my therapist must speak to their therapist about me. My issues and how I am doing in general. Maybe my therapist agrees that I only need every other week appointments. I don't know. I haven't seen him since the appeal. But he did say he was appealing it so I don't know.

I am just so f*cking frustrated with how one can be labeled "functional" because they can work or are "doing better at work". I am, by definition alone (not diagnosed), agoraphobic. I live in a tomb. In the dark. I am great at compartmentalizing to work and that's it. I go to work and home and that's it. I fast walk a store getting half of what I needed and normally have issue with that. I go no where else. So how the f*ck can I gain community support when the community scares the f*ck out of me?

Maybe my therapist is thinking WAY ahead with my dog's service dog training? He seems to not get how far ahead any accompanying me anywhere is and how long that is going to take. And until then, or if he fails, then I do this again, alone.

I'm sorry, this probably should have been a diary entry. I know this isn't no therapy but just loosing half my sessions for an entire year just feels like someone just ripped the rug out from under me, again!

 

[Justmehere]

I'm so sorry this is happening... ugh. :hug:

Don't lose hope. Appeal. This happens a lot. Appeal and hopefully your therapist can convince them of the need for weekly sessions. If you have an MD involved in your care, get them involved in the appeal too. Any symptom spikes or declines or things your therapist can report and get more sessions for too.

 

[SeekingAfrica]

I'm sorry you're having trouble! Honestly, I know how you feel. I obviously still have lots of issues, but things have definitely gotten better since I started therapy. I see my T weekly and it still doesn't feel enough on some weeks. Even without the mental issues I think most people would benefit out of that, but with mental issues, it's like a self-care things, it's necessary(with a good therapist of course).
Anyway, my insurance here would not cover that. There is no institution that would do that for me here. My insurance covered a first session with psychiatrist and nothing else.

Do you have a way to pay for it yourself? After some search I found therapist that was good for me and that I can afford. It's still quite a sum, but I do it and go weekly. I'm taking it as when I pay rent- I just need to pay that, for my health. Before I started therapy I had gotten to barely functioning level, I was too anxious to go out, see people, work almost at all...So it's a necessity.

I wish you luck with appeal, if that works where you are, then great. But here we have nothing that supports us that way, so you know...Okay in a way it's bad, but in a way it's good- I don't depend on someone deciding if I need this, so that's a bit of anxiety off.

 

[lostforgottensoul]

Do you have a way to pay for it yourself?

No. That's $250 a month. It's $125 a visit times 2 a month. Even if he cut it in half like when they left me in a hole that's still $125 a month. My dad & step mom are moving whenever she gets released from the hospital. I can't afford my expenses as they are. I may not have any tv and likely no internet either.

Don't lose hope. Appeal. This happens a lot. Appeal and hopefully your therapist can convince them of the need for weekly sessions. If you have an MD involved in your care, get them involved in the appeal too. Any symptom spikes or declines or things your therapist can report and get more sessions for too.

Can it be appealed after the first appeal? I'm so sick of insurences! I am so sick of "functional" being defined as can work or can't work. Working means nothing!

As for other Drs, I have kept my therapy as quiet as I can. For my pain Dr they ask you on a pain contract about suicide tendacies and stuff because they are giving you medication that can kill you if abused. I don't know if that contract is fully vaild now because of the internal pain pump so I let loose to him yesterday that I was training my dog to be my PTSD service dog (those words) and he didn't seem to fintch any.

My MD is a different story. I rarely see my MD because my MD is female. I was seeing her PA whom was male (and was referred to me by my therapist as it was his Dr. That's how much fear I have of people) and that PA left to go work in the new VA hospital that was opened here not that long ago so the PAs that replaced him are all female. She's nice enough I guess, females just terrify me and so I don't know. Like what would I say?

I have been wanting a new MD anyway. They used to be two blocks away and they moved. I'm just not sure how much to tell a non-therapist. Like, I am always scared something I say will get me admitted or something and then I'll loose my job and then I really won't be working.

Sigh, I don't know. I'm sorry. I am sick and this just hit me and my dad and step mom are still moving and how will i live on what I make and oh, yeah, my mom died in July and I haven't even began to work on that. It never stops rolling downhill does it?

 

[Lee2001]

I'm sorry. I really do hope something improves for you. I would keep in contact with therapist and do the appeals. That would be so hard on top of everything else you are dealing with.

 

[VioletButterfly]

I don't know how far out your appointment is, but have you called your therapist to see what he thinks about the denial? If he submitted a letter for the appeal, I'm shocked that UHC denied it. I'd get clarification regarding what your therapist sent. If he just had a conversation, I'd ask him to write a formal letter and submit it. Wow, even with Florida Blue (aka the stickler of all sticklers), a letter from a doctor would override any objection because of liability issues in terms of medical. As far as I know, they don't get up in your mental health business. I've questioned a denial of benefits (albeit dental) and the decision was overturned, so I think you can appeal a denied appeal. Hey, it's worth the work right now as you need the help. Good luck! VB

 

[lostforgottensoul]

If he just had a conversation, I'd ask him to write a formal letter

I haven't seen him but that was the denial to the appeal of the orginal "you can only go once every 2 weeks". Usually they are phone conversations but last year when they stuck me in an uncovered hole he had to do a written one as their therapist couldn't be contacted. That's not the case this time.

I haven't had a chance of seeing him yet as I canceled last Thursday due to being sick. He can call me between patients but only has a few mins generally so I will need to wait until next week's sessions (Fri) to really talk to him about it.

Florida Blue

Blue Cross & Blue Shield. Very different worlds. UHC gets up in your business. So much so that they employee a therapist of their own to converse with your actual therapist about all of your mental health business. My therapist says its the only insurence that does this.

And UHC Behavioral Health's likely issue, I've been covered for 8 years, weekly visits. But are you going to tell me that a therapist that has never spoken one word to me can tell me what I need in respect to mental healthcare? Nope, but UHC does it and if I had a choice of whom I would have as an insurence carrier it would NOT be UHC.

 

[scout86]

Wishing you luck! It sucks that insurance companies run the world. :( I imagine your T has run into this with other people too and knows what works and what doesn't. I hope he can get somewhere with them.

 

[lostforgottensoul]

Me too @scout86. I mean (now that I'm over that super pissed off hump) that it isn't the end of the world. I'm not not covered. And some sessions do feel a bit wasted as we didn't talk about much. But I can tell the times we skip a week (or more) and I am much less stable the 2nd week and not as focused I guess.

I don't know but I do know the mom thing is just under the surface but its huge and I am terried that once it blows, and I am now living alone....and walgreens is just down the street that sell, and I can legally buy, duster...you know? Even 2 years clean I know the addict mind. Hell 13 ish years off of coke and I know I'd do a line if it were in front of me. Duster is even harder as its legal to buy. And that was a scarier addiction. Ex roommates taking my pulse multiple times a night on a binge.

I could go on. Sorry. I could go all waky unstable and I could be fine. So many coulds that I shouldn't go there. Just a habit of rumminating i guess. Being physically alone is a big fear for me and the biggest transition for me (fully alone) since I've been in therapy that I think I would need therapy the most in that transition. If anything, to have someone physically there.

Also, I hate things being in the air. If I become unstable, then I have therapy next week. If this happens or that happens then I have therapy next week. It's just scary for me!

Also, I think Serquel XR played a huge role in this as it did indeed stabilze me. I just don't know if it did this much to lessen therapy. I guess I thought me and my therapist would decide together when and how to lessen therapy. Not some insurence therapist that has never met me or spoken to me.

I don't know. My rambling is all jumbled and make no sense. Blah :wtf: about sums everything up right now.

 

[Crow]

I have a choice of providers at work - probably twelve or more. I loved United except their mental health section. They refused any reimbursement at all. Luckily I could transfer to BCBS where they pay 30℅ of out of network. Good luck. They suck.

 

[lostforgottensoul]

I loved United except their mental health section.

No shit! That's why I am trying to advise specifically United Behavioral Health as it does branch of from the normal medical/prescription part of UHC.

I have a choice of providers at work - probably twelve or more.

Your lucky! In all jobs I had I was stuck with whomever they had in their group. Ugh! If I had any other choice, it wouldn't be this.

And my only grip with regular UHC is they force you to mail order certian meds. They used to give you a choice. Pay less if you mail order but nope. And one of them is gabapentin, the main med for the neuropathy in my legs. Without it I can't walk and am left screaming all day. From the day the Dr sends the meds (day of Dr visit) it takes them 10 days to process that. That meant i was 10 days, well 8, without it. Couldn't order it until the appointment which was exactly 28 days before the last. I had to have him send it twice, get ahead of it, for it to not leave me in a gapping hole.

Had the same issue with my thryroid meds.

Thier prescription play leaves much to be desired as a whole but I don't think that's UHC. I think that's my company's presciption plan?

Either way, it sucks!

 

[Muted]

My health insurence has denied weekly vists to my therapist and says I "don't meet the minimi...

That is horrendous, I would be so pissed!!! Just because they cannot see the wounds because they're not visible to the eyes DOESNT mean they're not there. I don't know how such stupid people get into positions to make those kind of decisions. Don't they realize that therapy is hard work?!

I'm sorry you're having to deal with this.