I got a letter this week from my insurance's behavioral health division informing me that a psychiatrist had reviewed my case, that I am chronically ill with no chance of being better and that what was going on was not my being worse, that I was unable to benefit from intense therapy, and that by standard clinical guidelines I was not only not allowed to have twice weekly therapy I was not allowed weekly therapy. Unless we win our appeal I will have to pay for every other week, plus all the 2nd visits I've had lately.
The appeal is pretty strong. The reviewer has no idea of my history, he is assuming based on my diagnosis. He is ignoring the fact that the previously submitted treatment plan had me at a level where I was functioning in an absolutely normal range, in full remission and that I sustained that until I reached a point where I was able to begin to address some of the issues that I had been too ill to face previously, and that this has triggered a clear case of PTSD which did indeed trigger cycling, but it was not random cycling, it was caused by a number of factors including PTSD and severe personal stress with work. Further there is a question of whether it is even legal to limit visits in light of our state's mental health parity act (or for a doctor not licensed in this state to dictate how I am treated, and I have a psychiatrist who is willing to say exactly what Dr. Mind is saying, and she carries the weight of being a specialist in bipolar at the Cleveland Clinic, not exactly a place known for poor quality of care. It was funny how much what her initial reaction was compared to his; they were practically word for word the same analysis of what has gone on. There are also two other really important facts: aside from being taken off my medication this is the worst I have been in 2 years, and WHAT WE DID WORKED. I'm rapidly recovering now and after next week will be back down to weekly visits because that's all I'll need. The reality is that Dr. Mind has treated me for a long time, and we know what works. We've learned over time that extra appointments both avert crises and make bad times better faster. This is very easy to prove in this particular case as the sequence went: started being symptomatic, increased visits, declined for a while, got better. That's never happened before. In the past we might have increased visits and I benefitted, but I have never before had an episode cause so much decline and then improve. And not just improve, but people, I handled a pelvic and catherization a few days ago WITHOUT TRAUMA. That is huge. Usually I cancel pelvics about 4 times before I have the guts to go through with it, and then I struggle for some time. This time I laughed during the exam. And why might I be able to do this? (And for the record I took LESS anxiety meds than usual that day just because of how I did the dosing and the time of the appointment). I can do it because I've worked through part of my PTSD. Which is HUGE. We still have to go back to that, and we will when I'm more settled (this is my last week at the job I've had since August; next week I'll start home health), but it won't be as hard this time. For one thing we will be prepared. For another, everything else is unlikely to fall apart all at once again; this time I did great until I found out my father made me run on a broken ankle, thus damaging my whole leg forever, then work fell apart, and it was just too much. There's obviously no way to keep life totally steady, but it is unlikely to have so much hard stuff at once again.
On a totally unrelated note, I know some of you are on the West Coast and this isn't the middle of the night. And perhaps someone else is awake. But please, please pray I fall asleep soon if you are reading this. I will be awake for the day in about 4 hours and I'm wide awake. Extra meds haven't helped. There is no reason. I am just not sleepy. This could mean that I'm so incredibly sensitive to meds that the topical high dose cortisone is causing me to be awake. Which is scary, since the topical foot med is helping and is my only option for getting the meds I need into that foot. It also could just be anxiety related to my last week, the need to gather up things and take them home, the whole change in what I'll be doing (long-term care may have become rather routine for me but I know what is going on and I have support available. In home health if I can't lift someone I just can't lift them; there is no external help. If someone is medically unstable I have to handle it, not just walk down a hall for a nurse. Etc. And that is scary. Although not so scary that I shouldn't be sleeping.......)