Needless to say, this means that my insurance has yet again disappointed me. I am now DONE with IOP, after they denied both our request for more days AND our appeal, which happened 5 days AFTER my last day that I was approved through. Which means that I have to pay for 4 days out of pocket. Fffffuuuuuuu... dgeballs.
This is their exact response, in the letter I received today in the mail, from Cigna in regards to the matter.
"The clinical basis for this decision is: Based upon the available information, your symptoms do not meet the medical necessity criteria of Cigna Level of Care Guidelines for Intensive Outpatient Treatment Eating Disorders for continued stay from 04/02/2012 as your treatment team has noted that you are still not completely sure you want to give up your eating disorder behaviors as a coping strategy. As they have identified the need for social support as being a need but you are still uncomfortable after nearly a year of intensive treatment groups, this will clearly take a long time if you are committed to continuing to work on it in a outpatient setting. As there is no specific intervention proposed that is likely to make a more immediate impact, you have already been exposed to the skills likely to make a difference in this level of care and further progress will not be immediately expected any faster at this level than in a pure outpatient setting."
... WTF????? so much confusion and contradiction in this my head is spinning. Dare I even try to refute? Here goes:
On the topic of motivation. Day to day, I have varying levels of motivation.
A. THIS IS NORMAL. Some days I want to get better, others I don't. They must have only looked at ONE day's worth of files, and it must have been the one right before the submission, in which I was crying my eyes out and felt that if my insurance didn't want to waste money on me, than I didn't want to waste the effort to get better either.
B. Lack of motivation, while it is a downfall to recovery, is not a personal flaw and the end-all be-all to whether I will succeed in recovery. It is temporary, and it is actually a result of our eating disorders fighting back at our attempts to combat it. In essence IT IS A SYMPTOM OF THE EATING DISORDER. Therefore, their argument is invalid.
On the next note, my therapist and I DID propose my plan for the next week in which I would stay in IOP and also make some other changes and progress and try to work my way up to inevitable denial that would come, so that the transition would at least be slightly smoother than all of the others that I've had to deal with (extremely rocky, thanks to CIGNA's habit of last minute notice). Obviously they didn't like that plan, so much so that they basically denied that it was even proposed in the first place!
Just so we're clear, and for the sake of honesty, here's how my eating disorder responds...
"OH, YOU DON'T WANT ME TO BE IN A SUPPORTIVE ENVIRONMENT ANYMORE? HELLO REAL WORLD, MEET ISOLATION AND EATING DISORDER!"
There's also, "OH, YOU THINK I'M BOTH NOT SICK ENOUGH FOR HIGHER CARE YET NOT MAKING ENOUGH PROGRESS TO CONTINUE WITH ANY OTHER FORM OF CARE? HOW ABOUT I JUST CUDDLE WITH ED SOME MORE?!"
And then there's always this one... "OH, YOU DON'T THINK I'M WORTHY ENOUGH FOR TREATMENT AND I'M A WASTE OF MONEY? MAYBE I SHOULD JUST DIE INSTEAD. THAT WILL SOLVE EVERYTHING!"
AMEN! I cannot believe that response. So ED here can say, "OH, LET'S SHOW THEM I AM SICK ENOUGH FOR THE CARE I NEED." Assholes. I believe in you Jess- all the way.
ReplyDeleteI hate insurance! I was inparient last summer and we had the most difficult time. We had several appeals and they ultimately denied part of my stay. Even though I met all the criteria, BMI, failure of outpatient, etc, they still said I did not meet "their criteria". They said in their letter of denial that I no doubt needed a higher level of care, but they would not cover it. It was a WTF moment. Seriously, you are telling me I need it and will probably die without it, but you will not cover it. Great, thanks! BTW...Cigna would not even cover me because of my eating disorder. We are small business owners so we had to apply as an individual. Because of the "pre-existing condition", they flat out denied me and said I was too high risk to even give me coverage. Dont get me started on Cigna!
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