I want to do a general update, and this time focus on Lizze. It’s been awhile since I’ve really talked much about how Lizze is doing, so I thought I should correct that.
As you may or may not remember, Lizze was taking a series of three, very intensive, outpatient therapy-type classes. These are designed for people with PTSD, Bipolar Disorder, and Borderline Personality Disorder. Lizze has both Biolpolar and PTSD. These classes have been enormously beneficial for her.
Unfortunately, after all three classes were approved, and she was halfway through the second one, insurance decided to no longer cover this therapy.
They didn’t provide a reason other than it wasn’t beneficial.
The staff at the Cleveland Clinic/Akron General fought to get this overturned but were met with the impervious red tape that hampers our health-care system.
There’s nothing we can do and she’s officially no longer in therapy there.
This came as a huge blow to her because these classes were really helping her to better manage her mental health and everyday life.
Putting the above aside, she’s struggling a bit physically. I’ve mentioned before, and she’s shared on her blog, that ehlers danlos is something that continues to be a problem for her. It will always be a problem, because it’s not curable.
Ehlers Danlos is a connective tissue disorder that causes extremely lose joints. As a result of this painful disorder, her extremities dislocate all the time.
Her hip can pop out, simply getting out of bed in the morning, when this happens, it makes a horrifying pop sound, and it hurts like motherfucker. It’s not uncommon for her shoulders and elbows to dislocate as well.
One of the most painful and disruptive issues she’s dealing with recently, aside from Fibromyalgia and chronic migraines, is pain on the bottom of her feet. My guess is it’s something like planters fasciitis, which is apparently common in people with Ehlers Danlos. It’s a very painful inflammation in the tendon that connects the heel to the ball of the foot. We’re working on getting her checked out.
All of these things take a heavy toll on her.
While I’m not inside her head, from the outside, she seems to be coping unbelievably well with all this pain and discomfort. She’s a lot tougher than I am, that’s for sure.
I don’t know how she deals with all of this and everything related to the kids as well.
This is just a little bit of insight, and I would encourage you to visit her blog by clicking here. Things have been so tough on her, that writing has been a very difficult thing for her to keep up with. It’s something she’s trying to get back into doing though.
If the classes (of a finite number) were pre-approved by insurance and then suddenly in the midst of the classes the insurance company decided to no longer cover them, that really sucks.
However, perhaps a gentler angle on Kim’s point — knowing now about the insurance company’s position, it’s a shame that Lizze was not in a better spot to take advantage of the classes the first time around. I understand that you’re saying sometimes these classes need to be repeated to achieve the full benefit, but even so, if you/she had known you were only going to get “one free bite” at these classes, maybe there would have been greater incentive to maximize their benefit.
And of course individuals with chronic conditions are “bad investments” for insurance companies – that’s why there are so many restrictions and procedural hoops to jump through once they see you as a liability that’s costing them too much, Maybe that’s what you called “the impervious red tape” above. But even so, insurance companies have to come up with a basis, justified by the terms of the policy, for denying coverage.
If that basis was simply that the classes “weren’t beneficial”, that’s something that can potentially be refuted. Sounds like the medical staff disagrees with the determination. While you said above that they “fought” for you, this is really your fight…with their assistance. The benefit of these classes would have to be demonstrated (within the terms of your policy, of course). You, as the policy holder, have the right to challenge/appeal the determination.
Sorry that Lizze is struggling. I understand why you don’t often go into detail about her condition here, but it does give greater context to everything else you talk about.
Thanks Jim. I try to let Lizze tell her own story on her blog, but sometimes she’s not in a place to really do that. I share here what is relevant in the moment, without telling her story. Does that make sense?
As for the classes, they were pre-approved and then canceled about half way through. No one has been able to get a straight answer other than shes a chronic case, meaning her challenges are long term in nature and cannot be cured by these classes. They look at cost vs benefit. That’s my best guess. I don’t know if the current state of the healthcare system is part of this problem. Lizze does have a insurance caseworker now and they will be meeting soon to figure some of these things out.
Insurance is a funny business and if I had to guess, I’d say that they stopped paying halfway through because they did a reevaluation and the insurance company decided that she either wasn’t meeting her goals or had already met them and no longer needed the classes. They may also have decided that they already paid for the class once and it was no longer something they wanted to pay for. In all fairness to the insurer. Lizze herself admitted that she only took the class the first time on a dare and that she didn’t take it seriously. I feel like she needs to accept some responsibility for the fact that this class is no longer being covered for her. That is a wasted chance for her and wasted money for the taxpayers who fund her insurance.
Kim, this really isn’t fair to make assumptions about things like this. You’re way off base in this one. From what we understand, this is much like Gavin and Speech Therapy. They see people who have chronic conditions as bad investments. I get it from a money standpoint but we’re talking about people’s lives.
It doesn’t matter how or why she began taking the classes. They help, but most people need to take it more than once. That’s simply the reality of these types of mental health issues.
For the record, there wasn’t any goals to meet. The class she was in was art therapy.
I know you mean well but frankly, you’ve no idea why they stopped coverage, and assuming she did something wrong, is not cool.
I didn’t say she did anything ‘wrong’. Insurance companies are super fickle and will come up with arbitrary goals which they say need to be met. A good doctor or therapist will know the proper wording to make sure that coverage is continued. I go through this once a month with the woman who provides my PT.
I understand what you’re saying. In this case, it doesn’t work like that. All three classes had to be approved prior to starting them.
If the classes (of a finite number) were pre-approved by insurance and then suddenly in the midst of the classes the insurance company decided to no longer cover them, that really sucks.
However, perhaps a gentler angle on Kim’s point — knowing now about the insurance company’s position, it’s a shame that Lizze was not in a better spot to take advantage of the classes the first time around. I understand that you’re saying sometimes these classes need to be repeated to achieve the full benefit, but even so, if you/she had known you were only going to get “one free bite” at these classes, maybe there would have been greater incentive to maximize their benefit.
And of course individuals with chronic conditions are “bad investments” for insurance companies – that’s why there are so many restrictions and procedural hoops to jump through once they see you as a liability that’s costing them too much, Maybe that’s what you called “the impervious red tape” above. But even so, insurance companies have to come up with a basis, justified by the terms of the policy, for denying coverage.
If that basis was simply that the classes “weren’t beneficial”, that’s something that can potentially be refuted. Sounds like the medical staff disagrees with the determination. While you said above that they “fought” for you, this is really your fight…with their assistance. The benefit of these classes would have to be demonstrated (within the terms of your policy, of course). You, as the policy holder, have the right to challenge/appeal the determination.
Sorry that Lizze is struggling. I understand why you don’t often go into detail about her condition here, but it does give greater context to everything else you talk about.
Thanks Jim. I try to let Lizze tell her own story on her blog, but sometimes she’s not in a place to really do that. I share here what is relevant in the moment, without telling her story. Does that make sense?
As for the classes, they were pre-approved and then canceled about half way through. No one has been able to get a straight answer other than shes a chronic case, meaning her challenges are long term in nature and cannot be cured by these classes. They look at cost vs benefit. That’s my best guess. I don’t know if the current state of the healthcare system is part of this problem. Lizze does have a insurance caseworker now and they will be meeting soon to figure some of these things out.
Insurance is a funny business and if I had to guess, I’d say that they stopped paying halfway through because they did a reevaluation and the insurance company decided that she either wasn’t meeting her goals or had already met them and no longer needed the classes. They may also have decided that they already paid for the class once and it was no longer something they wanted to pay for. In all fairness to the insurer. Lizze herself admitted that she only took the class the first time on a dare and that she didn’t take it seriously. I feel like she needs to accept some responsibility for the fact that this class is no longer being covered for her. That is a wasted chance for her and wasted money for the taxpayers who fund her insurance.
Kim, this really isn’t fair to make assumptions about things like this. You’re way off base in this one. From what we understand, this is much like Gavin and Speech Therapy. They see people who have chronic conditions as bad investments. I get it from a money standpoint but we’re talking about people’s lives.
It doesn’t matter how or why she began taking the classes. They help, but most people need to take it more than once. That’s simply the reality of these types of mental health issues.
For the record, there wasn’t any goals to meet. The class she was in was art therapy.
I know you mean well but frankly, you’ve no idea why they stopped coverage, and assuming she did something wrong, is not cool.
I didn’t say she did anything ‘wrong’. Insurance companies are super fickle and will come up with arbitrary goals which they say need to be met. A good doctor or therapist will know the proper wording to make sure that coverage is continued. I go through this once a month with the woman who provides my PT.
I understand what you’re saying. In this case, it doesn’t work like that. All three classes had to be approved prior to starting them.
Insurance is a funny business and if I had to guess, I’d say that they stopped paying halfway through because they did a reevaluation and the insurance company decided that she either wasn’t meeting her goals or had already met them and no longer needed the classes. They may also have decided that they already paid for the class once and it was no longer something they wanted to pay for. In all fairness to the insurer. Lizze herself admitted that she only took the class the first time on a dare and that she didn’t take it seriously. I feel like she needs to accept some responsibility for the fact that this class is no longer being covered for her. That is a wasted chance for her and wasted money for the taxpayers who fund her insurance.
Kim, this really isn’t fair to make assumptions about things like this. You’re way off base in this one. From what we understand, this is much like Gavin and Speech Therapy. They see people who have chronic conditions as bad investments. I get it from a money standpoint but we’re talking about people’s lives.
It doesn’t matter how or why she began taking the classes. They help, but most people need to take it more than once. That’s simply the reality of these types of mental health issues.
For the record, there wasn’t any goals to meet. The class she was in was art therapy.
I know you mean well but frankly, you’ve no idea why they stopped coverage, and assuming she did something wrong, is not cool.
I didn’t say she did anything ‘wrong’. Insurance companies are super fickle and will come up with arbitrary goals which they say need to be met. A good doctor or therapist will know the proper wording to make sure that coverage is continued. I go through this once a month with the woman who provides my PT.
I understand what you’re saying. In this case, it doesn’t work like that. All three classes had to be approved prior to starting them.
If the classes (of a finite number) were pre-approved by insurance and then suddenly in the midst of the classes the insurance company decided to no longer cover them, that really sucks.
However, perhaps a gentler angle on Kim’s point — knowing now about the insurance company’s position, it’s a shame that Lizze was not in a better spot to take advantage of the classes the first time around. I understand that you’re saying sometimes these classes need to be repeated to achieve the full benefit, but even so, if you/she had known you were only going to get “one free bite” at these classes, maybe there would have been greater incentive to maximize their benefit.
And of course individuals with chronic conditions are “bad investments” for insurance companies – that’s why there are so many restrictions and procedural hoops to jump through once they see you as a liability that’s costing them too much, Maybe that’s what you called “the impervious red tape” above. But even so, insurance companies have to come up with a basis, justified by the terms of the policy, for denying coverage.
If that basis was simply that the classes “weren’t beneficial”, that’s something that can potentially be refuted. Sounds like the medical staff disagrees with the determination. While you said above that they “fought” for you, this is really your fight…with their assistance. The benefit of these classes would have to be demonstrated (within the terms of your policy, of course). You, as the policy holder, have the right to challenge/appeal the determination.
Sorry that Lizze is struggling. I understand why you don’t often go into detail about her condition here, but it does give greater context to everything else you talk about.
Thanks Jim. I try to let Lizze tell her own story on her blog, but sometimes she’s not in a place to really do that. I share here what is relevant in the moment, without telling her story. Does that make sense?
As for the classes, they were pre-approved and then canceled about half way through. No one has been able to get a straight answer other than shes a chronic case, meaning her challenges are long term in nature and cannot be cured by these classes. They look at cost vs benefit. That’s my best guess. I don’t know if the current state of the healthcare system is part of this problem. Lizze does have a insurance caseworker now and they will be meeting soon to figure some of these things out.
Insurance is a funny business and if I had to guess, I’d say that they stopped paying halfway through because they did a reevaluation and the insurance company decided that she either wasn’t meeting her goals or had already met them and no longer needed the classes. They may also have decided that they already paid for the class once and it was no longer something they wanted to pay for. In all fairness to the insurer. Lizze herself admitted that she only took the class the first time on a dare and that she didn’t take it seriously. I feel like she needs to accept some responsibility for the fact that this class is no longer being covered for her. That is a wasted chance for her and wasted money for the taxpayers who fund her insurance.
Kim, this really isn’t fair to make assumptions about things like this. You’re way off base in this one. From what we understand, this is much like Gavin and Speech Therapy. They see people who have chronic conditions as bad investments. I get it from a money standpoint but we’re talking about people’s lives.
It doesn’t matter how or why she began taking the classes. They help, but most people need to take it more than once. That’s simply the reality of these types of mental health issues.
For the record, there wasn’t any goals to meet. The class she was in was art therapy.
I know you mean well but frankly, you’ve no idea why they stopped coverage, and assuming she did something wrong, is not cool.
I didn’t say she did anything ‘wrong’. Insurance companies are super fickle and will come up with arbitrary goals which they say need to be met. A good doctor or therapist will know the proper wording to make sure that coverage is continued. I go through this once a month with the woman who provides my PT.
I understand what you’re saying. In this case, it doesn’t work like that. All three classes had to be approved prior to starting them.
If the classes (of a finite number) were pre-approved by insurance and then suddenly in the midst of the classes the insurance company decided to no longer cover them, that really sucks.
However, perhaps a gentler angle on Kim’s point — knowing now about the insurance company’s position, it’s a shame that Lizze was not in a better spot to take advantage of the classes the first time around. I understand that you’re saying sometimes these classes need to be repeated to achieve the full benefit, but even so, if you/she had known you were only going to get “one free bite” at these classes, maybe there would have been greater incentive to maximize their benefit.
And of course individuals with chronic conditions are “bad investments” for insurance companies – that’s why there are so many restrictions and procedural hoops to jump through once they see you as a liability that’s costing them too much, Maybe that’s what you called “the impervious red tape” above. But even so, insurance companies have to come up with a basis, justified by the terms of the policy, for denying coverage.
If that basis was simply that the classes “weren’t beneficial”, that’s something that can potentially be refuted. Sounds like the medical staff disagrees with the determination. While you said above that they “fought” for you, this is really your fight…with their assistance. The benefit of these classes would have to be demonstrated (within the terms of your policy, of course). You, as the policy holder, have the right to challenge/appeal the determination.
Sorry that Lizze is struggling. I understand why you don’t often go into detail about her condition here, but it does give greater context to everything else you talk about.
Thanks Jim. I try to let Lizze tell her own story on her blog, but sometimes she’s not in a place to really do that. I share here what is relevant in the moment, without telling her story. Does that make sense?
As for the classes, they were pre-approved and then canceled about half way through. No one has been able to get a straight answer other than shes a chronic case, meaning her challenges are long term in nature and cannot be cured by these classes. They look at cost vs benefit. That’s my best guess. I don’t know if the current state of the healthcare system is part of this problem. Lizze does have a insurance caseworker now and they will be meeting soon to figure some of these things out.
Insurance is a funny business and if I had to guess, I’d say that they stopped paying halfway through because they did a reevaluation and the insurance company decided that she either wasn’t meeting her goals or had already met them and no longer needed the classes. They may also have decided that they already paid for the class once and it was no longer something they wanted to pay for. In all fairness to the insurer. Lizze herself admitted that she only took the class the first time on a dare and that she didn’t take it seriously. I feel like she needs to accept some responsibility for the fact that this class is no longer being covered for her. That is a wasted chance for her and wasted money for the taxpayers who fund her insurance.
Kim, this really isn’t fair to make assumptions about things like this. You’re way off base in this one. From what we understand, this is much like Gavin and Speech Therapy. They see people who have chronic conditions as bad investments. I get it from a money standpoint but we’re talking about people’s lives.
It doesn’t matter how or why she began taking the classes. They help, but most people need to take it more than once. That’s simply the reality of these types of mental health issues.
For the record, there wasn’t any goals to meet. The class she was in was art therapy.
I know you mean well but frankly, you’ve no idea why they stopped coverage, and assuming she did something wrong, is not cool.
I didn’t say she did anything ‘wrong’. Insurance companies are super fickle and will come up with arbitrary goals which they say need to be met. A good doctor or therapist will know the proper wording to make sure that coverage is continued. I go through this once a month with the woman who provides my PT.
I understand what you’re saying. In this case, it doesn’t work like that. All three classes had to be approved prior to starting them.
Insurance is a funny business and if I had to guess, I’d say that they stopped paying halfway through because they did a reevaluation and the insurance company decided that she either wasn’t meeting her goals or had already met them and no longer needed the classes. They may also have decided that they already paid for the class once and it was no longer something they wanted to pay for. In all fairness to the insurer. Lizze herself admitted that she only took the class the first time on a dare and that she didn’t take it seriously. I feel like she needs to accept some responsibility for the fact that this class is no longer being covered for her. That is a wasted chance for her and wasted money for the taxpayers who fund her insurance.
Kim, this really isn’t fair to make assumptions about things like this. You’re way off base in this one. From what we understand, this is much like Gavin and Speech Therapy. They see people who have chronic conditions as bad investments. I get it from a money standpoint but we’re talking about people’s lives.
It doesn’t matter how or why she began taking the classes. They help, but most people need to take it more than once. That’s simply the reality of these types of mental health issues.
For the record, there wasn’t any goals to meet. The class she was in was art therapy.
I know you mean well but frankly, you’ve no idea why they stopped coverage, and assuming she did something wrong, is not cool.
I didn’t say she did anything ‘wrong’. Insurance companies are super fickle and will come up with arbitrary goals which they say need to be met. A good doctor or therapist will know the proper wording to make sure that coverage is continued. I go through this once a month with the woman who provides my PT.
I understand what you’re saying. In this case, it doesn’t work like that. All three classes had to be approved prior to starting them.