Insurance: The Greatest Barrier to Recovery (Part 2)

For two harrowing weeks, my team exhausted their appeals trying to convince my insurance company that I was too sick to remain in day treatment. Not only did they refuse residential, but they also decided that I no longer qualified for PHP treatment:

To add insult to injury, the denial letter that my insurance company sent cited my weight. I had not known my weight since the beginning of treatment in an attempt to break my obsession with the number on the scale. And I was so controlled by the ED at the time that, when I opened the letter, I was more upset by that number than being denied treatment.

However, according to my insurance company my lack of weight gain wasn’t the only reason why both residential and PHP treatments were unwarranted:

• I was uneasy about taking an antidepressant and was still discussing the pros and cons with my psychiatrist—my insurance company called this “medication noncompliance.”
• I was struggling to open up about my eating disorder to my family, especially to my mother—my insurance company considered this an unwillingness to involve family support.
• At my lowest points, I relied on alcohol to quiet the ED voice and get me through a meal—my insurance company decided that, in order to continue treatment, I would have to attend Alcoholics Anonymous meetings.

But I was desperate. So I filled my prescription, called my mother to tell her I needed residential treatment (an extraordinarily difficult conversation), and I went to AA.

By the end of the two weeks, my insurance company still hadn’t budged. Meanwhile, my therapist was becoming desperate. She recommended that, if the requests for both residential and PHP were denied once and for all, I should allow myself to be discharged, wait two weeks, and then schedule an evaluation to start the treatment process anew. By then, I would be “sick enough”—and maybe even sicker—to be referred to residential treatment right off the bat.

It was the lowest of low points. We were so desperate that we were actually willing to let me spend two weeks with my eating disorder just to convince my insurance company of its severity. And my ED was jumping at the opportunity to show everyone how extreme we could be when left to our own devices.

At the eleventh hour, a high-ranking administrator in the program called my case manager to insist that I had the DTLA benefit.

Suddenly the answer became, “Sure, no problem.”

Simple as that.

Battling insurance proved to be one of the most difficult aspects of treatment. Those two weeks caused profound stress and fear as we watched the hope for recovery grow increasingly dimmer. It also intensified my ED behaviors.How could one person have so much power over my healthcare as to potentially disrupt the entire course of my recovery? What if I hadn’t had an extremely dedicated and tenacious treatment team?

In the end, I was fortunate. Residential treatment was one of the most valuable experiences of my life—it gave me the time and space to focus on nothing else besides getting myself physically, mentally, and emotionally healthy. But how many others have been denied treatment and have paid for that decision with their lives?

Joanna Kay is a writer in New York City who is recovering from an eating disorder. She is the author of The Middle Ground, a blog that deals with issues at the midpoint of recovery. This fall, she will be regularly blogging about eating disorders for Healthy Minds Canada. Visit her blog at middlegroundmusings.com and follow her on Twitter @_middle_ground  and Facebook at facebook.com/middlegroundmusings.