Denied Weekly Sessions

[steel]

I get it. I have had to move my weekly therapy sessions to twice a month because United Health Care left the health care marketplace and it's no longer covered by any of the remaining plans. Money is extremely tight and I am going to have to scuttle this week's session because I don't have the $80 to cover it.
I hate it because I was into my first year and a half of therapy and I was making such great strides. Once every two weeks was really not enough. I am trying very hard to take this in stride, but I have been getting triggered left and right and am scared to death that I am going to start sliding back into the hole.

 

[lostforgottensoul]

am scared to death that I am going to start sliding back into the hole.

Yep, I am already in that hole. And for what? Because your tight ass huge company wants to save money? We are talking about therapy here. Many times life or death. It is that important and I feel they will ask for my first born next and deny me until I have that first born. I mean f*cking seriously!

And I don't know how clearer my issues can make it that I need weekly visits. I just don't.

I'm tempted to call UHC Behavioral Health whrn I am suicidal and ask them if they help with these things since they took half of my therapy appointments away.

It's ridiculous. I know I have slide down this hole. My therapist knows it. We both also know how distructive i have recently become.

Oh god. You know what I just realized. The fact that I am owner training a Service Dog and his letter is in my records. f*ck! Another reason to deny me. Though he is too early in to accompany me many places or do his tasks while ok. Oh god! A trainwrek coming!

 

[steel]

All I can do at this point is work on the next best things... daily readings centered around acceptance, meditations...

 

[scout86]

They're doing this because they're bureaucrats and this is what they do. Dint bother looking for it to make sense.

On the plus side, they haven't turned you down, things are still in process. There's a good chance this will work out the way you want it to. (I really think they make it hard and stupid, hoping people will give up.)

I can't see why you needing a service dog should hurt your case here.

Good luck.

 

[recoveringfromptsd]

Got the letter back about the appeal today and they state they need complete medical records...

Sometimes the only insurance companies get it is when it results in decompensation and hospitalization under emergency conditions. I had the same crap getting into sheppard pratt, had a bed waiting but insurance company was stone walling, I had to go to the ER next to pratt suicidal and then it was no problem.

 

[lostforgottensoul]

I can't see why you needing a service dog should hurt your case here.

Not that I need one but that I have one. Though he is still in training and early in that training it will look to them that I have a service dog thus can do more and function better etc. So why would I need weekly visists when I can gain community support and if I am very afraid of in person meeting then I have my SD (in training) to help me gain those community suppots. How I am viewing how they'd see it as Chopper isn't trained enough to do that.

I don't know, my SD in training was brought up by someone earlier in the thread and my answer was the insur comp doesn't know about him nor shoud they but now they will. It was about making sure they know he isn't fully trained yet so i dont know.

On the plus side, they haven't turned you down, things are still in process. There's a good chance this will work out the way you want it to. (I really think they make it hard and stupid, hoping people will give up.)

No they haven't but while they take their sweet time (plus I have to wait for my therapist whom has to do all of this before or after work or during lunch as he doesn't have enough time between patients so I have to wait for him too. But while waiting for all of this, I can only see my therapist every 2 weeks or self pay the other weeks. At a time where weekly appointments are rather important. And UHC Behavioral Health takes FOREVER to do something. Last year they left me in a not covered hole for about 4 months and then took another 2 months to refund my money. So its a long drawn out process.

And they likely do this to try to force people to give up. Im not one of those people.

I had to go to the ER next to pratt suicidal and then it was no problem.

I so don't want to get to that point for many reasons. And I don't want make it seem worse then I am currently as I don't want to be Baker Acted (72 hr hold). So I don't know but SUPER frustrating! They act like I am asking for the world when I just want my weekly outpatient sessions back.

 

[VioletButterfly]

Just throwing this out there as you seem to be doing everything you can...

Have you reached out to the Department of Insurance? It oversees the carriers. I have called them 2x regarding issues with Blue Cross and the representatives were very supportive and helpful. When I moved forward with the last instance, a letter was sent (with a deadline) to light a fire under that big blue butt and I got results within 30 days. If your issue does not fall under its exact purview, it has been my experience that the DOI will at least send a notification letter regarding your concerns and also will provide you with options/suggestions on who might be better able to assist you. It's worth a call.

The only other option I see is reaching out to the Agency for Health Care Administration (AHCA - FL), but I believe it deals more with providers and facilities. Again, someone might not be able to directly advocate on your behalf, but might be able to offer guidance.

Hoping for the best outcome for you. VB

 

[VioletButterfly]

Quick post - have you, your therapist, looked into mental health parity laws? If not, a quick search might net some helpful info. I looked at the entries on the search result page for the APA, NAMI and the DOL. Just a thought as it seems your plan might not be in compliance with this federal law if you have 50+ employees at your organization. Might want to touch base with the FL DOI and work it from this angle? Just a thought. Hang in there. VB

 

[lostforgottensoul]

if you have 50+ employees

10 of thousands of employees. 3800 people was about 8% of their entire workforce.

Might want to touch base with the FL DOI and work it from this angle?

Hmmm, will look into that. It's always worth a try, right? My plan is unlimited visits in a year. They just "re-up" every year.

Thanks for the info!!

 

[VioletButterfly]

Oh my goodness! You'd think they could negotiate a better health plan for their employees with such a large risk pool! Ah... corporate America. Stingy stinkers! :p

Good luck!

 

[lostforgottensoul]

You'd think they could negotiate a better health plan for their employees with such a large risk pool!

We used to until ObamaCare f*cked it up. We had a PPO that had amazing coverage. Still United Health Care meaning still United Behavioral Health but I went the first 6 years with zero issue and then have an issue two years in a row. It just so happens thats when the PPO was taken away and replaced by a CDHP (consumer driven health plan. Which is just a health savings plan that the company pays part of) is when they started to f*ck with my therapy.

It sucks! I hate it! I miss my PPO but I have no choice. Its a CDHP or a Health Savings which the company doesn't pay part of and doesn't pay for a sick person to have. Health savings are for healthy people.

 

[VioletButterfly]

OMG - I just wrote a scathing response and realized I'm too caught up in this insurance mess. So much anger as it is such a fudaisey and has been so for so many years. I was working with a carrier when the CDHP came onto the scene. What a joke. I paid the monthly premium but never accessed care and I refused to pay into the HSA. I couldn't afford either on the pittance I was paid. To me, an HSA is a mandatory (when linked to your plan, even partially employer funded accounts) FSA that rolls from year to year (along with what the investments make). In living hand to mouth, this is an extravagance and not an option. I detest insurance carriers - heartless money grubbers! It's all about their financial bottom lines.

About the ACA - In my experience and understanding, the ACA is an oxymoron. What about it is affordable? From what I'm hearing and have experienced, It seems to have negatively impacted availability and access to care for those of us needing routine care as we can't afford the premium or upfront deductibles. For me, I'd pay $11,000 for insurance coverage and deductible in 2017. I'd have to meet a $4500 deductible before the carrier would pay $1. How is that affordable for me and others? How is that fair? Plus, even if you have insurance, there are so many restrictive formularies pinning folks down that we can't get the care and/or medications we need. Your case in point. Grumble, grumble!

I haven't had coverage since last July. I was told that I didn't meet the income threshold for a subsidy and that Medicaid wasn't an option because our wonderful governor opted out of the subsidy (Even "Pitch" Mitch McConnell took the Fed up on this hand-out!). What?! Thanks, no unemployment for me and no access to medical care (not even catastrophic coverage).

Sorry, mini rant. All to say, I understand your frustration, and I'm so very sorry and hope this gets resolved in your favor.