Advocate for Insurance Payments and Secure Help From Advocacy Groups

Posted by Jeannie Delahunt Aug 24, 2009

I have a personal beef against insurance companies when it comes to paying for treatment.

When I was an active substance abuse counselor, almost thirty years time span, I observed over time how insurance companies restricted and pulled back what they would and would not pay for. I ran into situations where the people making the decisions did not know anything about treatment or the issues found in the substance abuse field. I also ran into situations where those making decisions in the insurance industry were therapists, doctors, but whose decisions were based, not on the treatment issues at hand, or how a client was progressing in therapy. I had one doctor say to me, "This client has been in treatment many times. This is the last time. The client has burned too many bridges. Obviously, this client is not serious. We will not pay for any further sessions."

How can that person play God? There are so many instances where people have to relapse several times before he/she can get a footing. It is just the nature of the treatment issue. And I personally, have seen people, when insurance companies where more generous, go in and out of substance abuse treatment many times, before they were finally able to stay sober.

It finally came to a point, where, in order for a person to have treatment extended the client had to be either suicidal or homicidal. Now, if someone was neither, but was obviously still in severe need of therapy, having only those choices available was, in my opinion, cruel and inhumane. I had clients who chose the suicidal route, because they knew they just could not be discharged. Now, how unfair is that?

A client has to lie, then have it go onto their medical record, just to obtain the treatment needed to help build a solid foundation for recovery? And of course one of the mandates of recovery is honesty - honesty - honesty!

Then I have another beef, and that's with treatment providers/agencies who let the insurance companies mandate treatment. I saw it time and again, where, a client who was not ready to be discharged was ordered to be discharged, because the agency would not strongly advocate for the client. The therapist could not strongly advocate for the client through fear of being disciplined or fired. What's wrong with that picture?

For anyone working in the field, yes, insurance does cost and treatment is costly, but, consider the alternatives? When treatment is not adequate enough, relapse is inevitable. What's the cost to society in terms of jail time? Hey folks, who pays the taxes for people to go to jail? Who pays the courts? The funeral expenses? The loss of work time to employers? The tentacles are far reaching and far more costly than what it would cost for insurance to pay for adequate treatment.

Though, I've not heard of anyone going to jail for an eating disorder, but, what about the emotional and mental costs to families and employers? What about the "hidden costs to society?"

Not to mention the heartache - who can put a figure onto that? Unfortunately, this was one of the core reasons I could not, ethically, remain in the treatment field. I could not stand watching someone relapse when I knew and felt in my gut that just a few more days or a week could've made all of the difference.

Thus, I cannot urge enough, those of you seeking treatment, no matter what the issue, ADVOCATE, ADVOCATE, ADVOCATE! Create a support system who can help you to do that, too, so you can keep your focus on treatment issues. Taking on the system is daunting!

Please let your state and federal representatives, lawmakers, know the struggles you experience, whatever country you live in. They make the laws. Don't give up! DON'T GIVE UP!

And, if you are having a serious problem, e-mail me. I would gladly publish your story. It may help others.

Blessings!

Please see: EatingDisordersCoalition.org