Tuesday, September 22, 2009

Miscellaneous Clarifications

Hi all, just wanted to do some blogkeeping and clarify some things that I may have been fuzzy about in recent posts.

First, I'm afraid that my last post didn't come off quite as I had hoped. I want to emphasize that I intended for it to show that I'm learning not only to acknowledge that negative side effects of ED slippage but to refuse to settle for them. I lived with hair-clogged drains for years, hated it, but felt too trapped to do anything about it. I feel like I'm moving beyond that, I think I have at least caught some glimpses of how much better life is post ED, even if it is just for the sake of better hair days. ;p Kidding, there are way more benefits than that. Anywho, I didn't mean for the last post to be a call for attention/sympathy, I wanted it to just be a reminder of some of the fringe benefits (better hair, etc) that come from taking care of yourself.

Second, therapy. I have switched to a new therapist at the same clinic, and everyone involved was extremely graceful, professional, and understanding about my decision. I have gotten many comments about the fact that some non-ED therapists can be just as helpful as specialists, depending on the dynamic, and I would have considered someone else if changing my medical approval were not such an excruciating ordeal. I know I have some readers not from the U.S., so in a nutshell the system (at least with my insurance company) works like this:
  • I have to get a referral from my primary care physician to see a psychologist
  • If the psychologist is "out of network," meaning not on a list of providers that have signed on to work with my particular insurance company, my physician must submit a detailed letter with the referral explaining exactly why I have to see the out of network provider.
  • The insurance company takes its sweet time processing the referral (four weeks, in my case).
  • The insurance company commonly rejects the referral immediately, because no one bothered to look at the justification letter.
  • If the insurance company finds anyone else in the city within their network of subscribers that claims to treat eating disorders, they reject my referral and tell me I must see Dr. Network instead of someone of my own choosing, or I receive no coverage.
  • If I have any appointments before the date that the insurance company recieved the referral, they are not eligible for coverage.
Thus, if I want to change psychologists, I must get a new referral, new justification from physician, and wait several more weeks for it to process, leaving me in the lurch as far as therapy if I want to wait and make sure the referral is approved before going to any sessions. If the claim is rejected, I have to pay out of pocket for the therapy sessions.
This entire process is a huge ordeal and pain in the ass, which makes it very difficult to shop around and try different psychologists to find one that fits my needs. Seeing someone in the same practice is perfect for me at this point. Anywho, I just wanted to acknowledge that I appreciated everyone sharing their experiences with a variety of treatment styles, and that is definitely something I will keep in mind in the future!

Ok, off to bed., morning comes early these days. I was over at Match's place most of the evening, and am in that weird state where my body knows it's bedtime but it also jazzed up on caffeine from earlier in the day.

5 comments:

Jessie said...

So glad you were able to switch therapists. I'm sorry about all the insurance crap--that shit totally sucks, sucks, sucks. I hate insurance companies. Hang in there, and know that I am sending good thoughts your way. I really enjoy your blog and you're really an inspiration.

Sarah at Journeying With Him said...

C, don't let the haterz get you down. Yes, I went there.

I actually don't think they're haterz, more like concerned people, but I know you and I know you're trying and I think you are succeeding maybe even more than you know. Keep at it.

Sorry about the insurance frustrations. Health care reform is imperative, as everyone in their right mind (really more like the "left" mind, oh I am a stand up comedian today) already knows. I was just doing a report on Medicare this morning and I was flabbergasted (although I should have already known this) that they don't cover yearly GYN or physicals. You know, because who needs prevention? The exact statement was "Medicare covers medically necessary services you get from your doctor in his or her office, in a hospital, in a skilled nursing facility, in your home, or any other location. Routine annual physicals and gynecological (GYN) exams are not covered." It sounds like your insurance company is having a similar approach to your health--i.e. "specialty care is not medically necessary" but they need to run their risk assessment differently because the medical complications of your slipping will be a lot more expensive than whatever their percentage of your copay is for specialty mental health services. If only I ran the world...

lisalisa said...

I hope things are working out with the new therapist.
I know what you mean about the hair. I have to keep mine pretty short beacause the ED has really done a number on it.

Telstaar said...

Hey Chicka,

I'm just catching up on posts and stuff. Thanks for explaining how things work with your insurance carrier. I'm aware of the general system (or rather NON-system) of the US and thus also aware that its different for a whole lot of people even within the US...

Most of all, I'm just glad that you've been able to switch therapists within the same clinic. I know for me my suggestions (I think i made :S) around alternative therapists were more if that clinic wouldn't work or whatever etc but I am just glad its sorted! I want you to get help :)

So I really do appreciate you taking hte time to explain cause I don't want to be one of those annoying people that suggests things and you're like, "ARRGHHH! It doesn't work like that" hehe :).

Get well hunni! I know that is a really random thing to say and I know that you're doing your damndest to work on it, but I really want it for you. You're so smart and intelligent and I just don't want you held back by this wretched illness.

*sigh* I think part of this is desperation from my own situation but that just leads me to care more.

Thinking of you!
xo

Wrapped up in Life said...

It is so difficult to maneuver your way through getting the things you need. Resources are there, but to getto them you have to pull teeth. It's so stressful.

I guess that's why the rewards tastes so sweet, though. Hang in there.