by MeganM » Thu Jul 16, 2009 09:32 am
For some background, I am currently 20 yrs old on my parents' insurance plan. I was diagnosed with bipolar disorder 6 years ago and have been seeing psychiatrists and the like for longer (first diagnosis a year before was depression). A year ago I was victim of a sexual assault by an ex (he was also emotionally abusive in our relationship months before the assault). I hit a big depressive episode complete with losing interest in everything, lacking motivation, and suicidal thoughts. The suicide was mostly avoided because of the "my family would be devastated" factor. Needless to say, I was a wreck.
In May of this year, I enrolled in a mental health program at the partial hospitalization level. (I would have been inpatient, but I was not actively suicidal anymore.) Treatment was intensive cognitive behavioral therapy 9am-2pm 5 days a week. After 2 weeks of this, my insurance company decided that I no longer qualified for this level of care and dropped me down to intensive outpatient (9am-1pm, 3 days a week). The insurance company gave no warning to the hospital or to me when this level of care would end. After only 10 days of intensive outpatient, the insurance company once again decided that I no longer qualified for the level of care I was at and completely dropped my coverage for the program. Once again, they gave no warning to the hospital or to me that it would be ending so soon. I literally walked in one day to find out it would be my last day.
My last day was on a Friday. The whole weekend, I did nothing but sleep and cry. I barely ate, I didn't shower, I didn't take care of myself due to my depression. I relapsed in my self-injury, and I seriously contemplated suicide. (I suffer from abandonment issues, so this was like absolute torture. In my mind, they wanted me to suffer.) It basically undid all the progress I was making in the program. I had actually been getting my creativity back before this happened. I'm still waiting to get that back. I was also regaining motivation. Haven't seen it since. Over a month later, I still cry every time I think about it.
Slowly pulling myself together, I have found a therapist to try and sift through all the muck. (I figured that they obviously don't want me going to a hospital so why try.) Problem is, the only therapist in the area that fits my needs and is accepting new patients isn't in the network.
My question is this: is there any way I can get some sort of repayment from my insurance company for the psychological damages they caused? Can I sue them? Do I have to sue them? Can I make a deal that they pay for my therapist as if she were in-network in exchange for me not making a big fuss about the incident with the hospital?
I really want to get better and it seems like everything is standing in my way.
In May of this year, I enrolled in a mental health program at the partial hospitalization level. (I would have been inpatient, but I was not actively suicidal anymore.) Treatment was intensive cognitive behavioral therapy 9am-2pm 5 days a week. After 2 weeks of this, my insurance company decided that I no longer qualified for this level of care and dropped me down to intensive outpatient (9am-1pm, 3 days a week). The insurance company gave no warning to the hospital or to me when this level of care would end. After only 10 days of intensive outpatient, the insurance company once again decided that I no longer qualified for the level of care I was at and completely dropped my coverage for the program. Once again, they gave no warning to the hospital or to me that it would be ending so soon. I literally walked in one day to find out it would be my last day.
My last day was on a Friday. The whole weekend, I did nothing but sleep and cry. I barely ate, I didn't shower, I didn't take care of myself due to my depression. I relapsed in my self-injury, and I seriously contemplated suicide. (I suffer from abandonment issues, so this was like absolute torture. In my mind, they wanted me to suffer.) It basically undid all the progress I was making in the program. I had actually been getting my creativity back before this happened. I'm still waiting to get that back. I was also regaining motivation. Haven't seen it since. Over a month later, I still cry every time I think about it.
Slowly pulling myself together, I have found a therapist to try and sift through all the muck. (I figured that they obviously don't want me going to a hospital so why try.) Problem is, the only therapist in the area that fits my needs and is accepting new patients isn't in the network.
My question is this: is there any way I can get some sort of repayment from my insurance company for the psychological damages they caused? Can I sue them? Do I have to sue them? Can I make a deal that they pay for my therapist as if she were in-network in exchange for me not making a big fuss about the incident with the hospital?
I really want to get better and it seems like everything is standing in my way.
Posted: Sat Jul 25, 2009 11:00 am Post Subject:
Hello Megan,
Can I sue them?
Yes, you can, but whether you have a case or not only an attorney can tell that. You may contact an attorney for better understanding of your situation. Good luck!!
By the way, have you tried talking to the insurance company about it?
Posted: Sun Jul 26, 2009 07:14 pm Post Subject:
My first attempts talking to the insurance company were less than helpful. They would just side-step everything. However, a couple days after posting this question, I tried calling them again. This time I actually got a real human being! He looked over my file and fixed the payment for the hospital treatment and then made a note in my file that my therapist be covered like a participating provider.
Posted: Mon Jul 27, 2009 03:13 am Post Subject:
Well Megan, that is certainly a good news for you. However,
He looked over my file and fixed the payment for the hospital treatment and then made a note in my file that my therapist be covered like a participating provider.
Does this mean that you have used an out-of-network therapist? Have you been referred to him by your primary healthcare provider?
Posted: Mon Jul 27, 2009 07:01 am Post Subject:
I've never been required to have a referral to a therapist. I actually don't have a gp right now. And the situation with my therapist is that there was only one in the area accepting new patients who dealt with my issues, she happens to be out of network.
Posted: Mon Jul 27, 2009 09:18 am Post Subject:
What does your policy state about using out-of-network physician? The terms of coverage would vary between the policies and some policies won't cover out-of-network therapists/doctors if they are not recommended by the primary physician.
Moreover, what therapies have you received since the policy may also have exclusions regarding services that were rendered to you?
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