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Author Topic: Wanted to share GOOD news... and some more system malfunctions.  (Read 2082 times)
serenitygone
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« on: May 04, 2011, 01:09:54 AM »

Today is a good day in our home.

As you all know these don't happen every day.

MY BPDD GOT INTO DBT! 

she starts Thursday.  She came home from the "intake" and said...well that's 2 hospitals that say I'm BPD

and crazy enough for treatment"  She WAS laughing.

Now here's the system malfunction...

her insurance company is REFUSING to fill her new meds.  They say she's on too many psychotropics. ? ? ?

Hello...we're just now beginning to see OUR daughter...and they don't want to pay.

Her doc spent an hour arguing the point...to no avail.

Suggestions?  I'm gonna try to talk with the "case manager" at said ins. company. 

Prayers Please...without these drugs...she'll be back in hospital faster than I can type.

I will NOT allow this to ruin my happy dance  Smiling (click to insert in post) Smiling (click to insert in post)

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NeedToBreathe
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« Reply #1 on: May 04, 2011, 08:18:55 AM »

 Doing the right thing (click to insert in post)

Im glad you had a good day!  I know that feeling, when you see a piece of your child you love, if even for a moment!  Good for you 

DD25 has been down the insurance company road too.  They dont seem to treat psychiatric illness like they would other physical diseases and they put up so many road blocks like this.  Im sorry your running into one.  I hope your phone call makes a diffference...  good luck!

NTB
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lbjnltx
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« Reply #2 on: May 04, 2011, 09:47:03 AM »

perhaps some points to go over w/insurance company...

an md...pdoc...has prescribed these meds and to disallow coverage is to defy his medical orders.

these meds prevent their client from endangering herself and others..?...to disallow coverage is to endanger her and others and you may hold the insurance company partially liable should injury occur.

these meds may very well keep her out of the hospital and thereby avoid HUGE medical costs which the insurance company is bound by the policy to pay...( i assume).

many times policy holders are able to get exceptions on limitations...i hope you are able to do this!  kindness usually gets you further than threats...try kindness first!  if that gets you no where use whatever leverage you have...stay in your reason mind...insurance companies are businesses...businesses exist to make money...appeal to their balance sheet...emotional talk will most likely only make it worse  

let us know how being an affective advocate for your daughter turns out.

lbjnltx
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serenitygone
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« Reply #3 on: May 04, 2011, 06:47:45 PM »

Well here's the update...

the insurance people were beyond RUDE.  Basically, they told me that we don't get a say...they are the ultimate authority.

I did call the pharmacy back...they called them yet again...urghhhh

Now they need "more" info from the doc.  So again, we wait.

I am no quitter when it comes to advocacy.  I will fight to the death for what I believe is RIGHT.

Denying treatment IMO is against the hippocratic oath.  I prob will contact the Attorney General of MO before this is over.

so the saga continues...
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lbjnltx
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« Reply #4 on: May 04, 2011, 07:30:16 PM »

YOU GO GIRL!

maybe let the insurance company know that you are contacting the state board of insurance...they'll love that!
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 BPDd-13 Residential Treatment - keep believing in miracles
tiredmommy2
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« Reply #5 on: May 05, 2011, 05:34:29 PM »

Excerpt
Today is a good day in our home.

As you all know these don't happen every day.

Enjoy!  Doing the right thing (click to insert in post)  

Insurance companies...don't even get me started. I've been fighting with mine for so long now that it has almost become second nature.  Smiling (click to insert in post)  The sad part about this is that if she broke her leg, they would have no problem paying for that, but with psychiatric illnesses, it seems to be a constant struggle.

Persistence will pay off sometimes. Try to be nice (hard to do when you are frustrated, I know), but be a pain.  Call them, document when you call and who you are speaking to and the response you get.  If you don't get the answer that you need, ask to speak to their superior. Wash, rinse and repeat.

Niceness didn't work in my case so I ended up threatening them.  They forced a discharge from the hospital before the docs thought that she was stable, so I took her home where she almost immediately tried to commit suicide.  Since this was all so nicely documented, I told them that if my d harmed herself just because they were trying to save a few dollars, I would have a local news station at my house faster than they could blink.  Then I would start calling newspapers. They have no idea who they were messing with because I would have done it in a heartbeat!

If all else fails, there are non-profit organizations that will advocate for you.  If you did a google search, I'm sure you would find a few. 

Good luck with everything.  I hope that something works out for you. 



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serenitygone
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« Reply #6 on: May 05, 2011, 06:42:54 PM »

Thanks Tired...

I WON!

I can now go pick up the 2 meds. 

JUST FOR TODAY...I'm doing a happy dance.

till the next time...
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tiredmommy2
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« Reply #7 on: May 05, 2011, 06:45:32 PM »

Woo Hoo!  Doing the right thing (click to insert in post)   Smiling (click to insert in post)
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Grammy17201

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« Reply #8 on: May 05, 2011, 10:43:05 PM »

What great news!  Enjoy your happy dance!  You more than deserve it. 

Smiling (click to insert in post)         Being cool (click to insert in post) 

Hugs,

Grammy

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qcarolr
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« Reply #9 on: May 05, 2011, 11:47:12 PM »

I WON!

I can now go pick up the 2 meds. 

JUST FOR TODAY...I'm doing a happy dance.

till the next time...

We need to ask for a 'happy dance' icon. We sure need to celebrate any good news in a big way.

qcr
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The best criticism of the bad is the practice of the better. (Dom Helder)
NeedToBreathe
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« Reply #10 on: May 06, 2011, 08:52:23 AM »

GOOD FOR YOU!    Doing the right thing (click to insert in post)

Pat yoursef on the back and enjoy the moment!

NTB
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peaceplease
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« Reply #11 on: May 07, 2011, 08:53:49 PM »

Serenitygone,

Doing the right thing (click to insert in post) .  I am so happy for your victory.  Meds and willing to go to DBT - absolutely Awesome!  I hope things continue to move forward for you.  

peaceplease
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Auspicious
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« Reply #12 on: May 08, 2011, 01:49:25 PM »

 Doing the right thing (click to insert in post)

What are the two meds, BTW?
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