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.

Ray

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.

Ray

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!!!

Ray

WHAT THE HELL DO I HAVE TO Do TO GET TREATMENT??

what do i have to do to get treatment? we went to the new psychiatrist, and he basically said that he couldn’t help us. He also said that DID is just exaggerated BPD. he said that meds won’t help me and recommended that I continue to meet with my therapist and he’s not seeing us anymore. so much for providers actually listening to us!!! i mean, some of my providers have said that if i don’t get treatment, I will die! they don’t care!!

Ray

why DO I HAVE TO SUFFER?

*Trigger* mentions weight

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why do we have to continue to suffer? i dont know. all i know is 20% of anorexics die!!! one person dies every 62 minutes from an eating disorder. I’m 76% of my ideal body weight. what more does my body have to go through? why do my issues be so complex? my issues are keeping me from getting into treatment!!! i just hate this!!! sometimes, i dont care and just want to end my suffering! my heart rate has gotten as low as 43 and as high as 159, and no, i wasnt excercising. what the hell do i have to do to get the help i need?

i cant just go to the ER for fluids because of malnourishment because if i go to the ER, they bollis a liter of fluids in an hour which can cause heart failure. and i cant eat what i’m supposed to to gain weight, because of the risk of refeeding syndrome which can be fatal!! i really feel like i’m in a lot of catch 22s. Like what am i supposed to do? I have lost 80 pounds in the last year!!! i’m just so damn lost!!!

Ray

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.
Ray
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despair

So just got a message from our PCP that River Oaks isn’t an option and that our only options were Passavant psych unit which won’t accept us, and to follow up with our psychiatrist for the other medical issues. We’ve basically been told that the one place in the country that can help us with all our issues isn’t an option because of insurance. don’t even know why I even try.

Ray

what is for insurance for anyway?

what the hell is insurance for? if they won’t pay for the treatment you need? I was even told by someone from the insurance company that sometimes people die because they don’t cover the services they need!!! Like what the hell??? i don’t know anymore. if something doesn’t happen soon, I will become one of the 20% of anorexics who die.

Ray

Tired of getting my hopes up

Hi everyone,

So I’m tired of getting my hopes up only to have them – to again. I thought I was going to get to go to Renfrew in Chicago for eating disorder treatment. They recommended the residential program, so I assumed that they had that program at the Chicago location. I later looked at their website only to realize they did not have residential at that location. So even if they did do a single case agreement with my insurance, I would not be able to go as the residential location is in another state. I am done reaching out to people to ask for help only to be told that I can’t be helped or to be told by the insurance company that they’re not going to pay for something. I just wish something positive would happen! I don’t want to end up on the medical floor getting a feeding tube because insurance refuses to pay for the treatment that we need!

Ray