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I've been spending a lot of quality time on the phone with my insurance company lately. In the middle of all these battles, sometimes it seems like I might have to give up on therapy, insight, and analysis. Maybe I should give up on trying to enjoy or care about things; abandon the idea that my life deserves improvement. Does the insurance company prefer that I walk through life half-asleep? Maybe that's what everyone else does.

A recent history: Since I became a member in June 2004, Blue Cross had paid my claims for my psychiatrist. When I became a member, I was told to send my claims to Blue Cross, not United Behavioral Health (UBH). I began submitting these claims every other month. Because my doctor was out of network, approximately 70% of the charges were reimbursed. Now mind you, my doctor doesn't deal with ANY insurance plans - he feels that they're a waste of his time and energy. Some of his patients can afford to pay out of pocket and the rest of us fill out the paperwork and submit claims on our own.

After February of 2005 all my claims were denied. I called numerous times to inquire about this and each time I was told that the denial was a mistake, that the claim would be resubmitted and that Blue Cross would pay it. I submitted more claims as the months went by and all of them were denied. Finally, in September of 2005, I was notified by a customer service representative that Blue Cross should never have paid these claims - that they should have gone to United Behavioral Health.

Then they said that Blue Cross would not pay for any of the claims that were currently being processed. I complained because during the seven-month delay that they had caused, I had continued seeing my doctor. Blue Cross said that they would pay for one month because they recognized their mistake. But they would not pay for any other claims. They also added that "I should feel lucky to get that much" and any further complaints would never be addressed. I was told that a supervisor would call me but I was never contacted by anyone.

I filed an online grievance with Blue Cross in November of 2005 and was told that a decision would be made within a month. After a month had passed and I had heard nothing, I was directed to customer service representative. He informed me that they had no record of my grievance, and referred me to another customer service representative who told me that my grievance had been sent to UBH because it dealt with behavioral health services. I tried to explain to her that my grievance was with Blue Cross, and that UBH would have no ability to address my grievance, but she didn’t seem to understand. Finally, she created another grievance and forwarded my case to "a senior quality management clinician." I had to laugh when I heard the title. I asked her "whose quality is she supposed to be managing... mine or yours?" In February of 2006, I was notified that my grievance had been denied.

My chronic, major, and life-threatening depression should be covered by California’s parity laws. But because my doctor isn't "in their network" (or anyone else's) they were only willing to pay for 20 visits a year. Unfortunately, I'm already using those 20 visits to pay for my therapist (who is also "out of network"). UBH would probably pay if I switch to one of their (less expensive) providers. But I have a productive relationship with my doctor and continuity of care is essential in psychiatric treatment. Even if I could find a new doctor and therapist, they’d have to be UBH providers taking new clients. After months, I might not find the right person. I met a lot of caregivers in my time:

- The elementary school counselor at age 8
- The prep school counselor and consulting psychiatrist at age 15
- The team of doctors at the Institute of Living
- The other prep school counselor (since I couldn't stand the one that hospitalized me)
- The doctor at Cornell
- The therapist at Columbia
- The MFT in San Francisco
- The doctor at UCSF
- Three DBT therapists
- Two group therapists
- A marriage counselor
not to mention the doctors, social workers and therapists at: three hospital & one residential psychiatric program

UBH even refused to make a single case agreement. And why would I want that anyway? Once I did that, then their case manager would get to have a say in my treatment.

When Blue Cross denied my claims I was left liable for all the charges for this provider. If I pay out of pocket, my treatment would cost me over $20,000 a year. With the job I currently have, ALL of my (after tax) income would go to the bills. So I asked my parents for some of the money - the people who made me sick in the first place. I think the insurance companies really just want to make my life so difficult that i'll eventually just give up. Sometimes it feels just that personal - i've been identified as one of the sick and the weak and now it's their job to weed me out of the herd. This is the thanks I get for trying to utilize preventative and less expensive outpatient care.

Question: does it seem strange to anyone else that UBH's logo is a frown?