Even when someone with good insurance is a skilled navigator of our complex and dysfunctional healthcare system, she can be overwhelmed by the stresses and costs that accrue when finding and receiving care for serious illnesses. This powerful story by Suzanne Carver articulates some of the problems associated our healthcare system, problems that would be eliminated with a single publicly funded healthcare plan for all.
October 9, 2017 9:47 am
Eighteen months ago, our pre-teen daughter’s depression and anxiety swallowed her whole. We watched her sink deeper and deeper each passing week, powerless to pull her back. Night after night, I lay awake terrified for my daughter’s well-being, her future, her very life.
We had been here before. The year before, she had been in such a bad place that school became impossible, and I began homeschooling her. She started medication and therapy, eventually improving enough to return to school the following year. But, as is so common with these issues, months later she was in darkness once again.
Given my daughter’s acuity this time, her pediatrician referred her to a psychiatrist. I used to work in the mental health field, securing services for patients, and I readied myself to do the same for my daughter. I knew of the staggering lack of pediatric psychiatrists in our rural area. I remembered tearful conversations with parents whose children were in crisis, and there was nothing I could offer them, referring them, as a last resort, to the emergency room at their local hospital.
We got lucky. There was a local clinic where she could be seen in six weeks. It was better than I had feared, but still an eternity for our suffering child.
Intake personnel and our insurance company’s database verified the clinic was in network, and we began treatment. My daughter saw a different psychiatrist each visit (they rotate through, often via telemedicine, to fill the enormous need), restarted weekly therapy sessions and new medications. She slowly improved and began to look like our daughter again.
Then the bills started coming.
Do you know what’s worse than lying in bed replaying the hour you spent holding your sobbing child on the floor and cataloging ways she could harm herself in your house? Lying in bed with all those thoughts, plus the concern of how to pay for the help she so desperately needs.
Each benefit statement from my insurance company was coded the same: out of network, above the usual and customary charge. I was told that the clinic was in network, but the providers she saw, inexplicably, were not.
I have spent the past year fighting these bills, searching in vain for answers to my questions about the proper channels I should have employed to get my daughter care. I filed two appeals with the insurance company, contacted the insurance specialist at the clinic, spoke to the Maine Bureau of Insurance, went in person to have a billing supervisor review our case, and contacted our benefits administrator who appealed on our behalf.
Finally, my insurance company agreed to cover the providers as in network. But the clinic did not have a contract with our insurance company specifically for the providers she saw, so they did not have to accept the contracted rate for those services. They could charge what they wanted and bill us for the remainder.
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So, we received a bill for more than $2,000, the balance due after our insurance company had already paid.
I was vigilant and involved, every step of the way. I am educated, have good insurance and experience in the field. I advocated for my daughter, did my homework and verified our coverage. If this was the outcome for me, what happens when those suffering from mental illness who don’t have moms who can make 100 phone calls on their behalf need services? How are those more vulnerable, less confident, less knowledgeable or uninsured people supposed to navigate this convoluted maze of referrals and coverage when they should be focusing on getting their loved ones, or themselves, better?
I still don’t know how I could have avoided this bill, how I could have checked on providers whose names I didn’t know until the moment they walked into the treatment room. And, worse, I don’t know what to do differently in the likely event that my daughter needs psychiatric care again.
Most importantly, I look in the now smiling eyes of my daughter and sleep at night knowing she is OK. I would fight for her 100 times over. But must it be this hard? Why can’t providers and insurance companies work as allies with the people they service? This experience has left me questioning the integrity of the field and the intentions of the institutions, the very people I need as my allies on the mental health journey.
Suzanne Carver is a former social worker, and now works as a massage therapist and writer. She lives in Hampden with her family.