My Photo
Location: Minneapolis, Minnesota, United States

Diagnosed with Type 1 diabetes in April of 1980. I recognize the incredible mental struggle of living with diabetes. I hope to share my struggles, my successes, and everything in between.

Wednesday, February 02, 2005

And I actually PAY for this?

Insurance drives me nuts. It's so very frustrating that I can hardly stand it sometimes!

As I approach my 25th year anniversary of dealing with diabetes, the game has become more mental than anything. I feel that I know how to use the tools that are available, it's just a matter of applying them to the degree that they are most helpful, and using them to gain better control.

I started looking for some mental health resources through my insurance carrier (I won't mention names), seeking both a therapist and someone who can help me manage some existing medications. (The psychiatrist that had originally prescribed the medications had left the clinic a while back, and that clinic is not accepting any new patients (but I'm NOT a *NEW* patient! - whatever...))

This insurance carrier has a website that can be queried to find an "in network" resource, with criteria such as male/female, languages spoken, location, ethnicity, area of expertise, etc. The closest I can get to someone that specializes in diabetes is "Chronic Physical Illness" as a selection for "Area of Expertise".

This brings up a list of clinician names, addresses & phone numbers. It does not include a company/clinic name. It claims to be able to tell me if the person listed is accepting new patients, but I've found that it's not accurate (ie, I'll call to set up an appointment, and they are not accepting new patients - even though the list says they are).

So, you are presented with this (sometimes long) list of names & numbers. I've had such terrible experiences with this list. It's absolutely traumatic. I called one number, and was greeted by a woman announcing "Thank you for calling the center for victims of torture, how can I help you". Another place I called was a school, where the doctors were all in training (ie, not yet qualified to be on their own). Others will only accept new psychiatric patients if you are seeing one of their therapists. Others will only see you if you can stand on one foot, pat your head, rub your belly, where born on a full (blue) moon and the numbers of your SS# add up to a sum evenly divisible by 3.

The center for victims of torture?! Keep in mind, this is a resource for people who are having problems with their MENTAL HEALTH!! Let's see if we can push them over the edge rather than get them the help they need...

I even tried working with an "intake counselor" to see if they could provide any additional help. They just pulled up the same list I had been looking at and read off some more names & numbers.


Now there are a few names that I am aware of in regards to therapists that work specifically with diabetes (or are at least knowledgeable about it), or have diabetes. Of course, out of 4 or 5 that I know to look for, not a single one is "in network".

That brings up an interesting point that I want to bring up. I was not aware that it is not completely up to the provider whether they are in network or not. I figured that if they were not in network, that they (the provider) were just not willing to accept the discounted rates for their services. That may be a factor, but I also learned that the insurance provider limits the number of in network clinicians for each geographical area! This means that the above mentioned providers & clinicians may very well have applied to the network, but were denied because there were already enough therapists in the area. Forget about the fact that none of them currently in the network for that area deal with diabetes...

I was able to find a therapist by doing some detective work. I tracked down the clinic address for one of the therapists that I know deals with diabetes (had seen him at some events or expos). On the voice mail there were a handful of other names, one of which I thought I recognized from a booth at an expo. I check the list of providers, and that provider was listed as in network! I called back, left a message to find out if this person was the one I remembered, and sure enough it was! So I immediately set up an appointment (which is coming up next week - I'll keep everyone posted!).

How sad is it that I had to do all that to get an appointment with a therapist that knows enough about diabetes to help me with the issues I'm struggling with? Still working on a psychiatrist that can help manage my prescriptions.

And keep in mind that I pay ridiculous monthly premiums for this (non)service.


Blogger Violet said...

Hello Scott, I found your blog too :) I COMPLETELY identify with this insurance frustration. Some time ago, when I too was seeking a therapist--this was before my diagnosis, so I at least didn't have the added wrinkle of needing someone familiar with diabetes--I had to jump through many many hoops for my health insurance company. They had no list of approved providers in mental health at all; you could call and ask for a specific name to be checked, or you could be given three completely random provider names based on geography. That was it. And further...just to get STARTED on that process, I had to disclose my name and then answer invasive questions posed over the phone by the CSR, including "Are you currently suicidal?" (Well, I wasn't, but that you've humiliated me in this manner...) It was completely mortifying. I can only imagine how I might have integrated diabetes into the search. Aargh.

So--good for you for persisting and using your familiarity with the community to find what you need. That's really what it takes, isn't it? A level of self-advocacy that is very challenging, sometimes, to muster on one's own behalf when you're already dealing with the ongoing challenges of the disease itself. I hope you'll get what you need from this. For my own part, I've ended up teaching my therapist about diabetes as I've learned--not precisely ideal, but we had a strong rapport already, and I'd be set far back starting over with anyone else.

1:45 PM  

Post a Comment

Subscribe to Post Comments [Atom]

<< Home