Wednesday, March 20, 2013


Today my good friend sent me a picture of an article posted in our nearest big city's newspaper stating that the giant HMO that our insurance provides to us for our health care, is under investigation by our state for either denying care altogether or not providing care in a timely manner to their mentally ill clientele.

They were quoted as saying they offer "brief problem solution-focused individual counseling. Research shows that many of their clients improve after a single visit. In general, we do not begin treatment with individuals whose problems are of such a long-standing nature....such as chronic mental illness, lifelong personality problems, etc. We will refer such individuals to an appropriate non-nameless HMO facility, although this treatment will not be a HMO covered benefit and will not be paid for by HMO."

The state report concludes that these statements are in error because the plan is required to provide coverage for serious mental illnesses under the same terms and conditions as medical conditions. Distributing such material may have discouraged some enrollees from seeking and accessing medically necessary behavioral health services.

Dealing with this facility has often felt *impossible* for ME and I am relatively high functioning. I can't even begin to fathom someone who has anxiety, depression, or God forbid delusional disorders trying to find their way through these services. I often found myself, true to my co-dependent self wondering if I was wrong. Was I expecting too much? Am I asking too much of them? It didn't seem like I was. Our requests seemed reasonable, humane...but *every* thing resulted in long waits, calling a myriad of departments only to be sent to another department. Crucial information like "you are entitled to visits with our staff psychiatrist" or "you are entitled to 60 days of residential treatment" are left out and the whole program being based on failure to finally wind your way around to the department where you really needed to be from the beginning, but by now you have failed numerous times and *IF* you have managed to keep hanging in there, you feel like shit and walk in hanging your head in shame feeling worn out and defeated with an even higher mountain to climb looming in front of you.

After reading this article today, I at least feel validated. I wasn't crazy or over reacting. It is an imperfect system dealing with imperfect and ill people. There are follow-up investigations scheduled thank the Lord. I can hope for change and reading this motivates me to keep walking forward for some sort of change that will benefit my girl and others like her.



Dad and Mom said...

The cards at stacked in this arena. I deal with the insurance companies. I negotiate health benefits for our company. I have a difficult time dealing with them not just with mental health but especially mental health.

We went round and round when I was dealing with rehab coverage. I lost every time and I even called in the brokers I dealt with for help. Between policies written by lawyers paid for by the insurance companies. Appeal processes that are insurance company paid employees that make the decisions and load their fall back position using HIPPA as a stalling tactic even if you have signed and noterized releases.

Good luck and I hear HMO's are even worse.

Signe said...

More proof for me that we need to listen to and follow that inner voice. Somehow, we have to untangle the enabler voice from that inner voice from our own fears 'voice.' I'm glad you were validated. Also, you made me laugh with the comment, "I am relatively high functioning." :)

Tori said...

We have HMO. We get a new insurance starting 4/1 (another HMO) because my Husbands work stated our current HMO was raising rates which would have made us pay around $1600.00 per month for our family for crappy coverage. With our new one I think the rate is just under $1300.00 or $1400.00 per month that we have to pay for and that is a "discounted group rate." Trying to find a decent Mental Health Dr for B is so frustrating. I have no choice but to try to find someone on our HMO which even with our monthly payment has a huge deductable for Mental Health. It doesn't even cover B's wellbutrin I have to pay for that out of pocket. I spent hours one day trying to get a Dr to just call me back as most of them are not accepting new patients. Someone said, "You should have B doing that." I wanted to throw my phone at them. I am also relatively high functioning (I like that line) and I was ready to scream how could I expect someone with severe anxiety just to name one thing he has make these calls?

Anna said...

This is not just an imperfect system in an imperfect world. They are just plane decietful. I hate that!

It is amazing that you were able to make it work.

Anonymous said...

Hmm... if this is the same company I am thinking of, I can vouge!! When I was suffering from PPD after having my youngest I all but begged and pleaded for nearly 6mos to be seen in their "clinic". EAch time they lost my info, couldnt see me, forgot to call me back, you name it! One day I was literally climbing up the walls and saw my own PCP and she had to prescribe me meds!! I never did get the mental health clinic to return any of my calls. It was horrible.

Hence, why we are doing counseling outside of our health insurance now for the teen. I have ZERO faith in the system I pay dearly to have coverage for when it comes to mental health issues.

Oh boy... I could go on for days! Just so sorry your family is going thru this.