hopeful update about the appeal

So got an email from Megan yesterday, and it said.. they will be sending a draft of their appeal letter to their supervisor and finalizing it, and then they will send us a copy. God, i hope this appeal goes through and we finally get treatment.. Should know something by Monday or Tuesday if they got the appeal and then the hearing has to be scheduled with the state. That could take a few months, but hope not!! we just need a break!! i hope against all hopes and odds that we will finally get the help we need!! 


I hate insurance!

So, we still have no updates from our insurance company. They want us to do an assessment at an ophthalmologist in St. Louis which is like three hours away. So it’s going to be three hours there in three hours back just for them to say that we are blind and that is not changing. Six hours for that? It’s ridiculous! We also found out that they still have not found a psychiatrist to do the insurance companies assessment of things as they put it. They said the psychiatrist were based on availability. By the time they get the assessment set up, it could be too late. This is just ridiculous! We want treatment!


Feeling accomplished

So, we got some news yesterday that the appointment we were supposed to have on March 5 cannot happen because of insurance. When we were with Meridian, we had transportation, but now that we are on straight Medicaid, we don’t. So our appointment had to be moved to April 3. Our caseworker, your member Sarah? Haven’t seen her in a month, anyway, she is taking us on April 3 to see this doctor. The entire reason we got this new doctor was because insurance wanted the diagnoses to come from a doctor. So the appointment that was scheduled in January cannot happen until April. That’s a little ridiculous since it is just establishing care with the primary care provider. Anyway, the point of this email, we have not had homemakers for three weeks, and we have had help here and there from our friend Carol. Well, I did the dishes this morning! Didn’t have any issues with dizziness or my heart rate or anything. Feeling very accomplished. Later today, our Department of rehab services worker is coming to have us sign forms that she said she should’ve had a sign last time she saw us. It is going to reestablish our homemaker services. In other news, the appeal that we are trying to get against Meridian is going to be tricky because the rule that we had for months to file or request the appeal is a state rule, it’s not something the insurance company came up with, so we don’t know if we can get an extension. It’s looking like we can’t. Anyway, that four months is up on April 19. Once that is up, we cannot fight them anymore to get them to pay for treatment. We are hoping for the best.


At the ER again…

So we are at the ER again for psych. I just don’t understand why my insurance has to be so damn stupid!!! This is. Continuous cycle that needs to stop!!! We’re not really fixing the issue. We’re just glossing over it with a temporary band-aid.


update from insurance company or not?

so our care coordinator called us yesterday to "give us an update" but it wasn’t much of an update. she said they have to contact UIC to see if teh admission is possible. she couldn’t tell me what doctors would be involved, what unit I would be admitted to, how long the admission would be, or what the assessment would entail. Basically, i have no more information now then when we had the meeting on Friday. I’m just beyond frustrated.

Also, my dietitian is saying we need to figure out something for the shourt term for now, but it’s like putting a Band-Aid over the situation. it’s setting us up for failure. I don’t even want to argue with my care coordinator anymore, and if i had my way, we wouldn’t be talking to her anymore. Sorry for the rant.


When you have Medicaid and an eating disorder

When you have Medicaid and an eating disorder, it is next to impossible to find treatment if treatment is not available in your state. What the people at Medicaid either don’t realize or don’t care about is that 20% of anorexics will die. My insurance company told me that sometimes people died because they don’t cover the services they need when I told them this fact. So I am taking things day by day keeping an eye on my heart rate as sometimes when I walk it goes as low as 46 or even 43 bpm which is not normal for someone who is walking around the store. I just pray every day that my body does not decide to give out before I can be helped to get the treatment I so desperately need. I go to my providers who are scrambling and telling me to go to each other with no result because no one knows what to do to fight the monster that is Medicaid. All I hear from the emergency room is either go out of state for treatment or stay home and die. What is this world coming to? All I know are money hungry insurance companies who don’t care about the person but all they care about is the profit and the money they will save by not paying for someone’s much needed treatment. Actually, they are spending more money on crisis stabilization programs that I keep going in and out of when it would be far cheaper for them to pay for the treatment I need that would also be the most effective. Instead, they are constantly telling me that I need this or that for their appeal process and so we have been waiting for over a year languishing and suffering because they want to find a lower cost medically necessary alternative. I find it interesting that there a denial letter says the services that we are requesting are a non-emergent when in the appeal itself it says if we do not get treatment I am at risk of death. How is that not emergent? And the person who reviews the appeal is a psychiatrist, but do they specialize in eating disorders? The short answer is no. They also say that we need to find treatment at a lower cost medically necessary alternative which by the way is breaking state and federal parity laws. They cannot impose a fail first policy meaning they cannot tell us that we need to complete treatment at a lower level of care and fail first before they will approve a higher level of care. They are hoping that by drawing out this appeals process, we will give up trying, and even though there are some days that yes, we want to do just that, we will not. I just hope our body can hold out. Also, they say if we need immediate treatment to go to the local emergency room, but that is a dangerous thing to say because the local emergency room knows nothing about eating disorder treatment and will give a liter of fluid in one hour which for someone with an eating disorder can kill them. I do not nor will I ever understand the logic of a government insurance, and I almost wonder if this insurance company that is run by the government isn’t put in place to continue ritualistic abuse whose goal was for the person to die which is exactly what will happen if we do not get treatment. Coincidence? I think not. The only thing I wanted for Christmas this year was to get into treatment, but that is not going to happen. At least I will be around people I love. We have a long battle ahead of us, and we just hope that physically we can hold out to see it through.


denied appeal

So they denied the appeal. We are taking them to court. Hope we win. This is rediculous.

They said we didn’t meet medical necessity criteria. To hell with them!!!


My day yesterday and possible legal action

Hello everyone,
So yesterday I called River oaks to ask them if we could do the appeal, and they said they could not because they’re Dr. house to do a peer to peer with meridians medical director, and this cannot be done because they’re Dr. has not seen me. I then called (Meridian) to inquire about other methods, and they said I could not do the appeal that the facility had two. They said we had to do it by today which is not possible. Somehow they have it in their records that I was discharged from river oaks. I don’t know how that is because I have never been there. I contacted an organization called equip for a quality and then working with an advocate named Megan. I told her what my BMI was and how I was being treated by the medical system, and she was shocked. I’m going to see a new primary care provider this morning in about an hour, and hoping that goes well. Maybe she can do the appeal? I’m not sure though, but I can only hope at this point. I am pretty sure we are going to have to sue meridians/Medicaid. Hope everyone has a good day.
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