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Denied Weekly Sessions

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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 know! My therapist said they are usually like students or those trying or needing to get experience (he named off a bunch of things that I can't remember at the present moment but sounded right at the time). But they can potientally make a fatal decision so I am unsure how it's written so lightly like it is. That I can gain community support the other week. When the f*ck have I been able to gain ANY in personal support in, oh the 20ish times my therapist has tried to get me support. That's how we found this site. But this doesn't replace therapy. Its awesome to have but in no way does this replace a week of therapy.
 
I know! My therapist said they are usually like students or those trying or needing to get e...

Seriously, how many people do we all have to deal with on a daily basis that need help themselves, but don't even realize it or refuse it and causing destruction to those around them?! Yet, we realize we need help and try to get it and then have to fight through this kind of crap!!!! And they wonder why we have so much dysfunction in this world... Grrr...
 
lostforgottensoul-I am so sorry that they have done this. I am so sick of insurance companies and know all too well how this works. My co pay for therapy is $30 per visit now with a max of 6 visits. It would be laughable if no so damn sad. I hope that you can appeal and get what you need. Don't let them break you!
 
If your therapist is appealing their decision, he obviously doesn't agree with their decision.

That they dropped you to half your sessions isn't a reflection on how well you're doing. It's a reflection of bean counters and mathematical formulas that say if they cut 1,000,000 people's sessions in half, maybe 300,000 will appeal, and they've just cut costs x 700,000. It's not personal. It's math. Your therapist is the one to pay attention to. Not the bean counters.
 
Your therapist is the one to pay attention to. Not the bean counters.

Yeah but if they never cover me then I am still stuck with half my sessions cause this was an appeal of their orginal yearly "you don't need this" so that's why I am all crazed. We appealed last year and it left me in a hole of no coverage at all for months. Then took more months to refund the hundreds of dollars i spent on self pay.

6 years no issue and now issues 2 years in a row tells me they don't like that i have been covered this long. They explain it a totally different way but thats how it looks to me. Unlimited visits means zero to them.

If we have unlimited amounts of an apeal then I'll just having him appeal it but I will ask him to appeal in writing. We may already be past the time for the appeal. I don't know as the appeal was happening as my step mom was happening as i was getting sick and now the holiday so it just was boom, boom, boom.

I'll see if he can call me Monday to fax an appeal or something.
 
Now would probably be a good time to work on not catastrophizing this. The reality is, you don't have all the information. Some things that are likely true:
Can it be appealed after the first appeal?
Usually, yes. Three appeals is fairly standard.

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.
This is unfortunately normal. I had a service denied that was really necessary and helpful. It doesn't matter. This is often how it works. Now, I know that's no real comfort, but it may help you balance the thought to know that you could easily have this issue on any plan, and at any time.

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.
This is also frustrating, and also becoming more and more common. Needing to 'stack' the prescriptions with the mail-order company so you don't run out. Again - it's a pain in the ass, but it's not the medical community conspiring against you, and it's not even that you are having some odd streak of bad luck. These are all normal changes that insurance plans have been implementing.

If we have unlimited amounts of an apeal then I'll just having him appeal it but I will ask him to appeal in writing. We may already be past the time for the appeal
Usually, the appeal clock re-starts at each notification. So, 6 months for the first, and then if you are rejected, another 6 months from the date of the rejection for the second appeal, and etc. It doesn't mean you shouldn't move quickly; but if you have had one appeal denied, it will be better for you to talk with your therapist before he re-submits. I'd strongly recommend waiting til you see him next, if you can.

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?
I hear you. But I also want to point out that you've come farther than this. You don't just go to work and go home. When you are home, you do training with Chopper, and that's both outside and inside. You even went with him to sit outside Walgreens. I remember maybe six months ago, you got a coloring book you like and you went to Panera and managed to sit there at least once, maybe twice.

It's very easy to hold onto how we think of ourselves at our worst, especially when stress occurs. It's a kind of coping, but it's really maladaptive. The problem with it is, you can change your healthy behaviors back again to correlate with older, less skilled behaviors. Don't decide you can't do things. Look at the things you can do, alongside the things you can't do. Balance the thoughts. This is DBT, you have spent time with it, and you can do this.

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 feel like by allowing yourself to think this way, you are creating fears that may not even come to pass. You might not be carrying a grief time-bomb. Maybe you've been healing all this time. And you won't be alone, either. You have Chopper - whether he's a service dog or not, you and he are finally bonding and you've written a ton of positive stuff about that.

Remember when you were going to lose your job? That didn't happen, right?

I am not saying that insurance isn't a pain in the ass, stressful, and upsetting. It's all those things. But you should let yourself meet the challenge with the skills you have, now - don't revert to being the person you were even six months ago. The progress we make doesn't matter in the easy times - it matters in the tough times, like now.

If absolute worst, with the insurance, comes to pass - and you can only see him every other week - there are options. Don't think about paying for 2 sessions a month by yourself - budget out and see if you could do one, on a sliding scale. That would only leave you with one empty week a month, where you had to bridge two weeks. Look up what the free group resources are in your area. It might be time to start doing a support group; and it doesn't have to be for PTSD. It could be for depression/anxiety, it could be for loss, it could be for chronic pain, it could be for addiction...lots of options.

It'd be good for you to draft a budget, anyway (if you haven't already) - since you are going to be paying rent on your own. Figure out what might be reasonable. You can do this.
 
But I also want to point out that you've come farther than this. You don't just go to work and go home. When you are home, you do training with Chopper, and that's both outside and inside. You even went with him to sit outside Walgreens.

True.

I remember maybe six months ago, you got a coloring book you like and you went to Panera and managed to sit there at least once, maybe twice.

No. I got the coloring books, true, but didn't manage to get past my back porch. We spoke about going to Pandara Bread as its just across the street from Walgreens (so close) but I never managed to go. It was when I was starting to crate Chopper.

But I hear you. I have grown and changed in this year and your right, I do have a habit of thinking myself as like I had never grown or changed. It just scares me is all, I think.

It'd be good for you to draft a budget, anyway (if you haven't already)

Oh, I already do that and always have. I laxed off a bit as their rent was more then I needed for the bills (hense my savings) but will be starting that when they move. I delaying calling Bighthouse (now Charter...or what they are now calling Spectrum) to figure out how I am going to bundle my internet with possibly my tv, maybe no tv, as the lowest possible and ride my savings for a bit adjusting as I go. It's a great padding so I am not worried short term. Though I'd love to keep that savings for a car.

Also, my dad says he is giving me $200 a month until I can get over this insane fear of gaining a roommate. The last were part of the family, already known to me and before that I lived alone.

I moved out to Kansas City at 21. If paying bills since I was 12 has taught me anything its to budget well and be great with money. I know no one else tighter with a dime then I.

But you should let yourself meet the challenge with the skills you have, now - don't revert to being the person you were even six months ago. The progress we make doesn't matter in the easy times - it matters in the tough times, like now.

I hear ya. It's kind of like someone that studied hard for an exam and then forgets everything when they take the exam. Or at least that's how it feels.

And you won't be alone, either. You have Chopper - whether he's a service dog or not, you and he are finally bonding and you've written a ton of positive stuff about that.

This. This is the biggest. I realized, after writing my last diary entry that while being calm/stern ish with him to keep him settled during the fireworks (which he did amazing at), I walked out on the porch and saw about hundred people outside. After he was calm enough for me to sit back for a bit, I realized that I had not done what I have always done during fireworks....freak. I think learning (obviously by messing up) that I must remain calm at all times during training, which is already scary things for him AND me, it's slowly teaching me how to, I don't know, be calmer I guess. I know I can't walk out there amoung those people alone but I could do so with him. So it's certianly a positive in many aspects.

The exposure this is giving me and will give me is one of the biggest things my therapist likes about it.

Look up what the free group resources are in your area. It might be time to start doing a support group; and it doesn't have to be for PTSD. It could be for depression/anxiety, it could be for loss, it could be for chronic pain, it could be for addiction...lots of options.

I wouldn't be able to do that. Not without Chopper but if I did get him to a place where he could be rather quiet around people, possible as Florida does cover Service Dogs in training and gives them the same rights as actual service dogs. I just wouldn't want to without him behaving fairely decent. But we are close. With the abilties he has shown tonight I think he is close to learning to be around people and to ignore them.

Anyway, thanks for the reply. I know I am backpeddling myself. Habit I suppose. And I know I have new skills. I think just all the new. I haven't lived alone but for about a 6 month period since my accident in '09. I have, though, lived alone. But it's now very different was pre '09 everything was very supressed, denied, and forced forgotten so it is new territory, living alone with my past. But also with new coping skills. I guess I tend to scare myself out of stuff.
 
My therapist is appealing and says a firm no, I am not ready yet to reduce sessions and he feels that would be determental to therapy in general. So he is appealing, again, in writing.

He said last year he wrote PTSD, BPD, GAD, a big write out of my entire trauma and issues today, and that I may need therapy for the remainder of my life so why they would only talk about my anxiety and "doing better at work" (ahem, because I have no other choice).

The office staff called me early Wed morning and forced caneled every other week this month. I didn't have a choice to even self pay, they said "we are canceling" and "we have to cancel". My therapist said that is to "protect" me and to leave his schedule open those week for other patients.

However, since he is appealing and I am seeing him only ever week this entire month, he said to go ahead and schedule next month now for every week (as he get booked FAST! I normally have 3 months scheduled at a time and schedule again a month in advanced) and it is HIS scedule. He is in a group and shares the money he gets with the office staff but still, it is HIS schedule.

I go up to the office staff to schedule next month and they said they can't schedule every week (though he told me to) as the insurence is only approving every other week right now. Though he is appealing, though he said to do every week, though I can cancel if I need to, it took 4 office staff. FOUR. This supervisor and that one's syperviosr. The head office lady is a BITCH and screamed at me. My therapist wasn't there to see it but he will hear about it. She literally screamed at me, in a psychiatrist's office.

She did the same thing when I dropped our car keys between the floor and the elevator. That gap is where the car keys fell and it cost over $300 to get them out. But because the office staff yelled at me constantly which made me have a red zone blind explosion, my therapist refunded all of that money.

Anyway, I was trying to tell them that he gets booked fast so if they approve the appeal, I can't see him because he is booked. What the f*ck? He is my therapist! I am not going to be without the abilty to see him. Plus, we have SELF PAY! Like, it isn't any of your business how I pay that off week. As long as I am scheduled every week.

The really awesome lady that I always deal with understood but her bosses didn't and at one point she said "go ask [my therapist]. He gets booked fast and he ud appealing so I am scheduling every week". It took me to yell at the main office lady and say "I will self pay those weeks. f*cking schedule it" and she yelled back "then you are 100% responsible for self paying those weeks. Don't think you can not pay those weeks". WTF? First, I can cancel a day in advance and not HAVE to pay it and if my insurence approves this appeal I don't have to pay those weeks. I am not sure if they marked it as self pay only so if they did and the insurence approves the appeal, they will need to figure out how to put those weeks through the insurence. If they can't, I will cancel them. f*ck that lady!

Sadly, I thought it was a bit early to have my service dog in training there again so I couldn't gain his assistence.

I got my correct service dog for PTSD letter though so that's good. Had my apartment make a copy so they can't say he can't be here.

Anyway, f*cking "fun" day. But got the appeal going and my therapist's opinion on the matter. So that's good.
 
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My therapist hasn't sent the appeal yet. UGH!!!!!!!!! He has had 2 full weeks to do so. He said his weeks have been busy but come on!!! I can't see him but once every other week right now so I am suffering while he waits to appeal.

He asked what to put in there (trauma wise). I told him to tell them about every detail of my past. I dont give a f*ck, I just want to see my therapist once a week so what they know makes no difference to me.

Anyway, to be continued I guess.
 
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