Frustrations with the healthcare system

Trigger warning eating disorder and I don’t know what else
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So, I spoke to my care coordinator, Courtney, at the insurance company, and she said that as long as the state isn’t forcing them to pay for anything, they’re not going to. She said residential treatment will not be covered no matter what we do. She said I was going to have to find intensive outpatient or partial hospitalization program options. I told her that the closest one was two hours away, and she said, “well we provide transportation. “ I told her that that was not the point, but partial hospitalization was not clinically recommended by anyone on my team. I said to her, “do things have to get really bad before insurance will do anything? Or are they just going to let me die? I know my providers won’t allow that to happen, but still, I still wonder this. Why does the insurance have to govern the treatment we get when they are not even the professionals on my team? It doesn’t make sense. I don’t want to have to get down to 89 or even 85 pounds and have to do this continuous loop From inpatient directly back to outpatient, skipping three levels of care, but I really don’t see that we have a choice. As long as money hungry people are in charge of making the decisions about what they will cover for my healthcare, then I feel powerless. This is beyond my insurance company at this point. It is at the state level. I don’t understand why the laws in Illinois aren’t protecting us from this cruelty and depravity. It doesn’t make sense! Not only that, but my physical health problems are being blamed on my mental health. Eating disorders don’t cause hypermobile joints or scoliosis or any of the other symptoms of idiots that I have which doctors refuse to diagnose because insurance again won’t cover genetic testing. Insurance won’t cover my prosthetics to be replaced which I’ve had for 10 years. I don’t understand what I have to do to get the healthcare I deserve as a US citizen. I feel like I’m fighting for everything I’m asking for. I fought to have us recognized as a system. We have been fighting insurance for over two years at this point. Can’t even go to the doctor for a physical health issue without them saying that I need to get the Mental Health treated first before they can help with the other stuff. I probably sound like I’m complaining too much. I should be grateful that I’m alive.
Ray

HFS final ruling

So, HFS issued its final ruling and we received the 20 page letter today. They said that the insurance company did not have to pay for the treatment we needed and our request was denied. They also said that it did not find that what we were requesting was within their jurisdiction. They said it was more a grievance that we were saying that our insurance would not find an alternative treatment plan. So now, we have to first try appealing to the circuit clerk court in Morgan County, and if that doesn’t work, we take it to the district court, and then, if that doesn’t work, we go to the supreme court. So we are looking at another year maybe more before we can get the treatment we need. For now, we are focusing on school. We are getting a new Windows laptop from the Illinois assistive technology program next Wednesday we have no choice but to keep going. We are not going to give up even though some days that is what we want to do. We will fight as hard as we can. They won’t take us down without a fight!

Ray

The hearing results

So today we had the hearing. We didn’t get the results we were hoping for. Meridian tried to throw some off-the-wall legal crap to derail our plans, and it worked. My attorney’s have to do more research to try to combat their arguments. The treatment center also said that a PHP program will not benefit us that we need residential treatment. My entire treatment team is angry with them, and Medicaid has some ludicrous laws about paying for residential treatment. I guess only Illinois has these laws. We are going to use the parody law argument to hopefully help our case. I really hope that something happens, or eventually we will be going to the media.

Ray

a breakthrough!!!

so i have really good news!!! we’re very highly likely going to be going to be going to Aloria Health to go to treatment for the eating disorder. we’re filling out an application for Project Heal today and have already done the intake and hopx to hear back from Aloria today as to if we got in or not. Also, we get to keep our Social Security benefits and sece it’s not being paid for by insurance, there isn’t a limit on how long we get to stay there. i just have to go today to the indccpendent living center so someone can help us fill out the applicaity. Has anyone ever been to Aloria? What was your experience? So excited to start my recovery journey!!

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

Long talk with insurance care coordinator

So just had a long talk with the care coordinator whose over behavioral health for my insurance. She told me that residential definitely wasn’t an option, and she also said that if inpatient ED treatment was need that it wasn’t covered either. She’s concerned about the amount of re losing, but the things she could recommend were outpatient. She wants my team to all have a conference call to discuss the future of my treatment. I told her I would do my best to work with them even though they keep blowing us off. She said we needed to focus on the ED right now and the other stuff later. I guess that’s going to have to work for now. Every time something comes up in therapy about dissociation or an alter comes out to talk, my therapist is litterally speechless. I just feel like I’m running into briak walls everywhere we turn. I mean, heck, even my PCP said I wasn’t sick enough for treatment. So if oupatient doesn’t work, we’re screwed. I don’t even know what to say anymore.

Ray

Just got back from the hospital today

So, we just got back from the hospital. It was a frustrating experience. Everyone there was recommending residential treatment, but Medicaid won’t cover it. I know reallistically that I can’t afford to lose more weight but there are times when I just want to keep losing. I know it’s not a good idea. Also, my therapist wants me to bring in information for her about my DID and the ED. I can’t do her job for her. I’m not qualified to train her. She has no one to refer me to as no one around here has any experience working with DID or ED that takes Medicaid.

Meridian even director involved in my case, and they still said no that they wouldn’t cover residential. They even said that if we needed inpatient ED treatment that they wouldn’t pay for that either. I tried to get into Timberline Knolls, but that’s a long story. Here goes.

So a few weeks ago, I called TK to see about going there as my insurance said that they could do a one time single case agreement with them. I told them I was blind, and they said that they had to take it to their board of directors. I then did the intake asesment, and they said that there was no reason why I shouldn’t be able to get in. They then called me the next day and said that they couldn’t accept me because of the number of alters I have. That was a bullshit excuse. I honestly think it was just another excuse for them to cover up the whole blindness thing. Just not sure what to do.

Ray