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

Not sick enough?

So, my PCP told me that I was not sick enough for treatment for my ED. She said, “you’re physically healthy, you’re at the lower end of normal BMI, your labs look good (they were taken a month ago), insurance probably wouldn’t even pay for an intensive outpatient program or for just outpatient therapy. “She just said to eat six small meals a day (For snack size meals and 1/2 container of ensure twice per day). So basically, none of the professionals on my treatment team are taking things seriously. When they where you at the doctors office, they don’t even take the weight off for the weight of your clothes, so they do not get an accurate picture of how much you weigh. I just don’t know what to do. I can’t go to residential because my insurance doesn’t cover it. She asked me which behaviors and I had and I told her I restricted my food intake, and she said well you’re not anorexic or bulimic, and restricting alone won’t get you into inpatient (like restricting is less of an issue then purging). I’m just so frustrated because I went in today looking for answers, and I got nothing. Makes me want to recover less and less. Makes me want to get to that “sick enough “where people actually take me seriously. It’s sad that we have to do that.