When I first got sick again in 2002, my insurance company cooperated. At the time, my insurance company was Health Net and their behavioral health subcontractor, MHN.
• When I started to feel suicidal again, I called and asked to see a therapist. They gave me a list of providers. I called the list and found a therapist who could see me. I saw him once a week, for a few months and MHN paid for it.
• When the therapist suggested rehab, I called and they referred me to a bunch of programs that they would cover. They all looked a bit grungy – not the kind of rehab-by-the-sea you see on Dr. Phil. But they were real programs that MHN was willing to pay for.
• When the therapist suggested medication Health Net paid for that.
• When I got really sick and my husband took me to the hospital, MHN paid for it. Even though I knew Heath Net covered treatment at that hospital we waited in the lounge for four hours while they negotiated. My doctor had to battle mightily with MHN to let me stay for a month. Luckily, I was so sick, he convinced them and MHN paid for the whole visit.
When I got out of the hospital, they were hoping I’d be fixed and stop spending their money. But I was far from fixed. I kept seeing doctors and that’s when the problems began.
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My doctor in the hospital said I was still too sick to go home, so he wanted me to go to a residential program nearby. When I went to visit the residential program, they offered to contact Health Net to obtain authorization for my treatment. But it would take a week or two to process all the paperwork, they warned. What could I do - I couldn’t stay in the hospital for a few more weeks and I couldn’t go home? My parents offered to pay until the insurance kicked in. Then we could try to get their money reimbursed. It would have been healthier to separate from my parents, but they are wealthy and there was no way I could afford my treatment.
A month passed and we were still waiting for Health Net’s authorization. My parents were getting anxious and wanted to know what was going on. Finally, my therapist suggested I speak with the program’s director, “Lardlad.” I knew him already since he ran my dual diagnosis group. He was a former businessman and bar owner who got sober and had become a substance abuse counselor.
When I went to meet with him at his office, he was warm and gracious. He tried to squeeze into the armchair across from me but his rotund frame wouldn’t fit. He perched on the edge of the seat. I tried to explain the situation. As long as my parents were paying they had control over me. That’s why I was so persistent, I said. His acne scarred cheeks bobbed up and down in understanding. He’d take care of Health Net, he said.
A couple more weeks passed and nothing had changed. At first, Health Net claimed that my plan had been cancelled. One minute they’d never heard of me and then suddenly, poof, there I was on their computer screen. They’d lose a claim or process it wrong. I started thinking about all the time that had passed. My parents had already paid $8000.00. What if Health Net wouldn’t reimburse us, I asked Lardlad? The program had to get payment first, Lardlad said, his grin drooping with impatience. Then they’d help me get my parent’s money back. Maybe I should have done it myself, I said, twisting my fingers into knots. Maybe I could’ve fixed it right away. The therapist said he’d handle it, I said tightly. You said you’d handle it. My throat was choking. I didn’t want to cry - I wanted him to take me seriously.
Ok, he said, looking at the floor. That’s fair. From now on, I should just pay the co-pay. The rest would be the program’s problem. I went outside to call my husband and gloat. I wasn’t going to let anyone dictate what kind of care I got. I would yell until I got what I need.
After almost a year there still was no progress. I didn’t want to ask Lardlad about it, but I had to get my parent’s money back. Frowning, he said they were giving up on the insurance. How was I going to get my parents’ money back, I wondered, sighing?
“Don’t worry though, we’re still going to talk to Health Net about your doctor’s fees.” Lardlad said. I hadn’t been reimbursed for those bills yet either. I whirled around.
“”I see my doctor in his private practice. You guys don’t have anything to do with that.” I said, trembling.
“I know, but we’re going to help you with it.”
“Help me? It’s been over a year and you guys haven’t accomplished anything! Now you’re going to screw up my doctor’s bills? Why in the world would I want you to do that? You have no authority to meddle in my finances!” He followed me out onto the front porch.
“I don’t like the implication that my staff and I haven’t been honoring our promises. I’ve called Health Net over and over and spent hours on the phone. Your accusations are not appropriate.” My trembling turned to shaking. Why was he reprimanding me? Tears were splashing off my nose like a gargoyle.
“Stop, just… please! You don’t understand. My parents are calling me every week asking what I’m doing to get their money back. It lets them control my treatment. I worked so hard… “ He tried to speak but I was hysterical. “I never get away from them! They’re never going away! They don’t think I’m doing anything. I trusted you to help and now it’s a disaster! After a few minutes my therapist came out to comfort me and Lardlad excused himself.
Finally, I contacted the California board of Insurance and asked them to audit my file. Health Net paid us almost $20,000 and admitted that they had been negligent. It had taken them over a year.
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No matter how hard we fought, my care is still extremely expensive. Every week we pay almost $200 in co-pays. It takes hours just to keep track of all the bills. It doesn’t help that the insurance representatives can be rude. I try hard to be patient but sometimes we get into stressful arguments. Often, I’d hang up the phone, shaking with any number of emotions I’d restrained.
Gee, it’s like they know that mental illness compromises emotions and self-esteem, making it nearly impossible to stand up yourself…
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