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Mental health parity and why I hate insurance companies

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I seldom post about personal things here but I feel the need to spill my guts so here goes...

Last August we found out that my youngest daughter had been sexually assaulted. She had been having severe problems at home and school for several months before this came to light and we had been taking her to see mental health professionals. When the ongoing assaults were discovered things got even worse and she required hospitalization. Initially the insurance company denied coverage as we had exceeded the maximum number of visits for mental disorders. When I sent them a copy of the schedule of benefits I was given by my employer they reversed their decision. They called the hospital and authorized treatment. Several weeks later I was informed that there was a typographical error in the schedule and that they would deny coverage. The owner never signed the amended copy and too bad for you. No shit, I saw an e-mail from the insurance broker that said “Employee ------- has daughter hospitalized for M/N suicidal tendencies…probably no big deal, just a stressed out Mom” I am truly glad that the author of that e-mail was not in the same room with me when I read it but that is another story.

Anyway, flash forward to today, my daughter is still having severe trouble dealing with what happened to her, she is not doing well at home or school. Her depression is getting so severe that she requires hospitalization again. Money is the least of my worries but since I have ripped through every liquid asset I have paying for treatment, I am glad to know that the mental health parity act is in effect for any plan year that starts after October this year, some small measure of peace in the fucking hell we live in these days.

But no…. Even though the law clearly states that the effective date was on the first day of the plan year beginning one year after enactment of the law which for me was November 1st (the official signed by the owner plan document clearly defines the plan year as beginning November 1) the insurer has informed the hospital that they will be denying coverage because I have exceeded the maximum number of visits even though according to the law they are not allowed to do such a thing.

So yeah, my wife is a basket case, my daughter is having such trouble that she cannot even be safe in our own home and some cock sucker at the insurance company decides that they need to fuck with us just a bit more because they can and it might save a few fucking dollars.

I hate private insurance companies…. H-A-T-E them! Any law that by accident or design might put them out of business is okay in my book. Actually, I hate more people than I should at this point but anyone who works for a health insurance company or rapes children is at the top of my God Damned list.

Fiat justitia ruat caelum

Follow Ups:

RE: Mental health parity and why I hate insurance companies - tom1356 23:57:22 11/06/09 (0)
I wish there was something I could write that would help.
I wish you well.
Rotten - DWPC 23:24:47 11/06/09 (1)
Our system is lousy. Most people can get no mental health care coverage at all unless they enter a facility. Its infuriating that corporate bureaucrats can have such authority over peoples most intimate lives. And people fear the govt.!

"We must beware of those who burn with zeal but are not endowed with much sense." - Angelo Roncalli
- "And people fear the govt.!"... - Draz 03:54:08 11/07/09 (0)
  ...Excellent point!
  
  All I hear from other psychologists is "You trust the govt. to administer this....the same government that can't buy a toilet seat for less than $600?...." blah blah, blah.
  
  I've seen and experience far more ethuical atrocities at the hands of the private sector.
  
  By a long shot.
  
  The truth hurts, lies kill
  "The word God is for me nothing more than the expression and product of human weaknesses" [Albert Einstein]
If The Insurance Company is In the Wrong, Sue The Company................ - Todd Krieger 20:00:28 11/06/09 (11)
Provided what you stated was accurate, and you have **evidence** to the problem being caused by negligence on the part of the insurance company, you might have one whopping case. A potential award that might cover your future medical costs. (This is why I oppose capping awards. And it's a case where a reverse judgment, which I do advocate, seems out of the question.)

What bothers me is why you project the notion that if one insurance company messes up, it's an indictment on the entire industry.
- Its a cartel, not a business sector. - DWPC 10:26:47 11/07/09 (0)
  Wise up. Look around. A handful of corporations have a strangle hold on this economy and increasingly, the Congress. Yet the Right stands in terror of those in elected govt. still struggling against the corporatocracy. Are you paying ANY attention to what's going on regarding control of the financial sector and the govt?
  
  "We must beware of those who burn with zeal but are not endowed with much sense." - Angelo Roncalli
- "What bothers me is why you project the notion that if one insurance company messes up, it's an indictment..." - Draz 03:56:44 11/07/09 (1)
  ....The drive for profits has more of a corrosive effect than you could imagine.
  
  Believe me, you'd never see a governmental agency behaving is such a callous, callow manner.
  
  The truth hurts, lies kill
  "The word God is for me nothing more than the expression and product of human weaknesses" [Albert Einstein]
  - Draz, who do you think allows the corporations to operate as they do? Hint.............the government. * - gme109 08:32:00 11/07/09 (0)
    *
- GMAFB... - Scott Woebcke 20:12:19 11/06/09 (5)
  Let it bother you that somebody is very mad for having his child treated like she is inferior to a paper greenback. If that angers you then perhaps you should get help.
  
  All insurance providers are operating at very high costs and it is deliberate. There is no conspiracy. The health industry now wants to get involved in Washington because they are "too big to fail"
  
  I wish your free market rhetoric could be truthful but it is nothing but a delusion. There is no competition in health care right now. If you can't afford it you are not a member of the club.
  
  Could health care be cheap? Yeah...How cheap...that depends on the amount of greed in Washington and Big Pharma...We all know how the healthy competition keeps everything reasonable...
  
  Yeah...right.
  - Why Are You Making This Political??? - Todd Krieger 20:31:26 11/06/09 (4)
    As if the government would do better....... Now that's delusional.
    - "As if the government would do better....... Now that's delusional."... - Draz 03:58:42 11/07/09 (2)
      ...Wrong.
      
      Without the profit motive and with the scrutiny of the public they serve, they WILL do better.
      
      Much better.
      
      The truth hurts, lies kill
      "The word God is for me nothing more than the expression and product of human weaknesses" [Albert Einstein]
      - RE: "As if the government would do better....... Now that's delusional."... - TomD 07:48:07 11/07/09 (1)
        
        In Reply to: RE: "As if the government would do better....... Now that's delusional."... posted by Draz on November 07, 2009 at 03:58:42
        
        And costs will spiral out of control (like every other government run entitlement program) because there are no Profit/loss accountabilities. HC will worsen, premiums will go up and the defict will rise as will taxes.
        
        Name one government run entitlement program that isn't a financial disaster. No problem though, the gov can just pour unfunded funny money into it and kick the can down the road.
        
        Summarizing your post in just one word: BULLSHIT. Nothing of what you say has been proven true, while... - orejones 08:33:49 11/07/09 (0)
        
        In Reply to: RE: "As if the government would do better....... Now that's delusional."... posted by TomD on November 07, 2009 at 07:48:07
        
        ...the truth is, that in most countries where Universal Health Care has been implanted, it works, with variable success. Even in the UK, where that bitch Thatcher butchered it, it´s still better than what you have now...
        
        BF
    - Because the only possible solution will never come from those bastards repenting: either it comes from... - orejones 03:08:59 11/07/09 (0)
      ...the highest stances of government -the government chosen by the people, BTW...- or they will never change a iota in their fucking behaviour.
      
      Even a reactionary "libertarian" like yourself should be able to see that...
      
      BF
- That's the stuff Todd... - Jim Pearce 20:06:21 11/06/09 (1)
  Marty's life and family are just collateral damage. Why can't he see that?
  - RE: That's the stuff Todd... - Todd Krieger 20:29:38 11/06/09 (0)
    "Marty's life and family are just collateral damage. Why can't he see that?"
    
    What do you mean by collateral damage?
    
    Some guy and his family have gotten sunk by what seems to be negligence in handling of an application by an insurance company. Collateral damage implies damage where the intended action targeted a different party.
    
    We need to focus on a solution for this particular case.
I Hear Your Pain... - Draz 19:37:18 11/06/09 (0)
...As someone in the field I have had to deal with this for years. Often, when a patient is solidly on the road to an emotionally healthier lifestyle, they run out of benefits (Oxford, Healthnet and Magnacare have traditionally been the worst). What many of my colleagues will do at that point is just begin billing under another family member. I'm just too paranoid of losing my license so I usually agree to continue their treatment at a ridiculously reduced rate (sometimes $0). I've never been able to reconcile the ethics of cutting someone loose who's entrusted therir care to me merely because they've run out of benefits for that calender year. And I've given up fighting with the scumbag insurance companies because I simply don't have the time or patience to negotiate their myriad layers of bullshit.

So yes, the system sucks but Timothy's Law qwhich effectively madates mental health coverage parity with "regular" medical coverage is a HUGE step in the right direction.

Speaking as someone in the field, I would be very happy with a single payer system.

I don't know that I can offer you very much advice re: your daughter other than to applaud what you'cve obviously already done to secure her emotional recovery. I have a feeling that things are going to work out for all of you.

Hang in there!

The truth hurts, lies kill
"The word God is for me nothing more than the expression and product of human weaknesses" [Albert Einstein]
Sorry to hear that our for profit health care system is screwing another human being - gme109 19:35:25 11/06/09 (0)
Why is it that American is the only industrialized nation that puts profits before its citizens health?

Your story is very sad, and sickens me deeply. I wish you and your family all the best, and hope all of you come out stronger and more unified in the end.
RE: Mental health parity and why I hate insurance companies - sjb 19:22:36 11/06/09 (0)
Marty, I'm so, so sorry to hear this. It makes me sick to my stomach and hurts my heart.

My younger sister was molested for a few years (aged 8 - 11, I was 10-13) and while she never went to as dark of a place as you're describing, she did go to a pretty dark place. My family didn't have any real insurance battles to fight (or if we did I wasn't privy to them) so I have absolutely nothing to offer there.

I hope it's a tiny bit helpful to know that she's a happy, healthy, adjusted adult. It took a lot of work on her part (my parent's, bless, them, just weren't equipped to be much help) but she made it through with flying colors.

Again, I'm so sorry she had this happen and that you all have this pain.

"The man is only half himself, the other half is his expression." -- Ralph Waldo Emerson
One of my best friends is going through the same thing... - darkmoebius 19:08:38 11/06/09 (0)
She is actually a high school teacher, herself. She is engaged to a great guy who has a 14 year old daughter from a previous marriage. The girl was terrific in every way - good student, athlete, very social, happy as can be.

She started to get moody - what teenager doesn't? Just a phase, they thought. Then, her grades started to fall. She started dressing differently and abandoned almost everything she enjoyed doing, then got heavily into drugs and alcohol. This all happened in a very short period of time - approx. 6-8 months. They finally had to do an intervention on her and take her away to a boarding school for teens w/ emotional problems. There they found out that she had met "a friend" (teen) on MySpace who eventually convinced her to come meet him at a hotel. He turned out to be 65 year old man who flew in from out of town and sexually abused her several times over a weekend when they thought she was at a friend's house.

My friend is guilt-ridden because she cannot believe she didn't see the warning signs, and that is her profession. Made worse because she has seen the signs in her students before and tipped off counselors.

Anyway, they are in insurance hell because this is not the type of thing that is "cured" quickly. It will take years and years to repair the damage. They burned through their savings on the boarding school(and flying out to see her regularly) that year, but feel it was worth every penny because she couldn't get ahold of any drugs there AND in that setting of horses and open pastures the counselors were able to coax out what really happened.

The daughter returned home after a year at the school and now is enrolled at my friend's private high school. She seems to be doing much better, but is nowhere near the happy go-lucky girl she was a year ago. Obviously, trust is a big issue for her.

Anyway, I hope you can get some help from someone that has experience fighting insurance companies on these things. I know form my mom's 5 years of cancer that it is a constant battle for every little basic thing with insurers, even the things they are supposed to cover. Good luck and I hope things turn around quickly for your family.
Wore the same shoes - LWR 18:27:48 11/06/09 (4)
Jesus there is no easy way thru this minefield. My heart goes out to you and her and the wife. In our case it was a teacher and it was my son and a girl classmate. They were in the 2nd grade. When it came to light thru behavioral problems and we found out it was their 2nd grade teacher that did it two things happened. the teacher left town before I could choke him slowly to death and I told the school superintendent that I would own the land under every school in the city if these children were not provided with ALL the care and help they would require for ALL the time they required it.
10 years worth of psychiatric help, in most weeks 2-4 hours a week. Paid for in full by the district.
Hope it helps you to know that both the kids are fine and healthy and perfectly adjusted adults who are active in their communities and functional in society and their relations with those they know. The teacher was caught a year after he left and was sentenced to a long term. I cannot find out where he is or when I can go and meet him upon his release.
The school district was not released from any future help either my son or the girl may need at any time in the future.
I hope that all works out well and quickly for your daughter. There is no greater outrage, no greater anger than these things happening to out babies.
You all will ne in my thoughts for a long while...
- I truly hope your kid came out of this okay, LW. For 3 years, - tinear 08:47:27 11/07/09 (1)
  I worked as a caseworker/investigator/prosecutor paralegal in child protective services. I saw hundreds of similar situations; the hardest for me to deal with involved family members who were the actual abusers--- the victim's natural support system invariably was harmed if not destroyed. What about the poor families that cannot afford care in cases like this? I hope you at some point can empathize with other families not as financially sound as yours was. Their kids deserve the same chance as yours.
  - Thank you, Tin - LWR 14:21:38 11/07/09 (0)
    and he did turn out just fine, What may haunt him when he is alone I do not know, I am sure he must have some echoes, what they may be he either hides or they really are gone. He is healthy mentally and that is the result of thousands of hours of psychiatric care.
    All children deserve the care my boy and the little girl had....This should never happen in the first place ...
- I Have A Question For You.... - Draz 04:03:58 11/07/09 (1)
  ...While I'm happy that you and your family were able to get all the help you nedded, I'm not sure I understand (or agree) that the school district should have picked up the tab.
  
  If they had no knowledge of this teacher's conduct before it came to light, how does that make them liable? No one can be expected to know or predict the conduct of its employees. Certainly not unless there had been prior warning signs that can be proven that the district disregarded or swept under the rug.
  
  Just asking.
  
  The truth hurts, lies kill
  "The word God is for me nothing more than the expression and product of human weaknesses" [Albert Einstein]
  - When the events that had happened began to become known - LWR 06:09:51 11/07/09 (0)
    My father in law, a no nonsense active Agency guy, brought it to the School's attention. After a short while the teacher was send packing. There was no further action taken by the school. Since the events happened on school grounds they decided to pay all future care for the two kids rather than face our combined families in a 25 million dollar law suit that we began to file against them. In other words they blinked. We did not want to sue and go thru the public exposure, we wanted the kids to be cared for by the entity on whose property the molestations happened and were performed and directed by an employee of theirs.
    I do not know if they had knowledge of any previous acts by this teacher. Or if other kids had been victimized in that school district by the same guy. I know they shuffled him out of there and that he went somewhere in Northern Calif and was caught laying in bed with a naked 6 year old sucking his dick.
    Had it not been for my father in law handling a situation that more or less overpowered my wife and I and that we were too distraught to deal with in an efficient and sensible way, we may not have prevailed. He actually came to the house and removed my weapons. Rationality had abandoned my wife and I both. She wanted to castrate the bastard. I merely wanted to shoot him to death slowly.
    It is an ugly part of our family history and it took many years to decompress and for both kids to return to normalcy.
    Unless and until this happens to your own child you have no way of knowing the level of distress it causes and some children never are able to recover from such abuse. It all happened 27 years ago. I am still pissed.
Marty, - tinear 18:23:05 11/06/09 (0)
I don't know what to say except I'm sorry you're in such pain. As the father of a wonderful girl of 8, I can't even comprehend what you must be feeling. Anger is a great, normalizing emotion at times like this. Understanding is much harder. Get a heavy board and pound nails into it, go to a golf driving range, get a heavy bag... these displacement behaviors have worked for me in tough times past.
I'd suggest you and your wife consider joining parent groups dealing with these issues: most communities have them.
I'd also consider hiring the best tort attorney in your area (he or she most likely would LOVE to take this case on a non-fee, percentage basis). A jury would justifiably ream this company. This is why tort reform and limits is a bad idea. A nice fat award would send a well-publicized message to these cocksuckers.
You're a great dad to get all the help you can for her. Nowadays, there are medications which are far more nuanced than even 10 years ago, as well as many different kinds of therapy (I used to work with severely emotionally and physically abused kids).
The best of luck to you.

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