User’s Guide | Rules | Contact a Moderator | Registration or Login Problems? | Eating Disorders Learning Center | F.E.A.S.T.



Custom Search of F.E.A.S.T. and Forum Content:
Register Latest Topics
 
 
 


Reply
  Author   Comment   Page 2 of 2      Prev   1   2
mjkz

Avatar / Picture

Caregiver
Registered:
Posts: 1,264
Reply with quote  #26 
I'm so sorry Francie.  I do agree it is important for families and clinicians to give the same message.  My advice would be:
1.  Do things in writing if you can. 

2.  If you do call, keep meticulous records of who you spoke to at what time and what he/she promised.  I actually recorded all calls I made to insurance companies. 

3.  Be brutally honest.  I would describe what life was like going into residential and what is happening at PHP, how you see her slipping back to what was going on before residential.  It seems obvious that they stepped her down too quickly. 

4.  You are going to run into problems if your daughter is not telling her clinicians what is going on and being honest about her symptoms.  One word of advice I always give people when seeing their doctor is describe your worst day and what that is like for you even if you are having a better day because your team needs to know what your worst days look like.  Until your daughter stop minimizing her symptoms and comes clean though, you are fighting a truly uphill battle that you have little chance of winning. 

5.  Ask her to keep a diary of what she is eating or not eating in this case, any purging, etc. so you have factual proof.  Her clinicians can only share what she shares with them so I wouldn't hesitate to offer to share what is really going on so they can help you make the best case possible. 

6. Tell your daughter the only way anyone can help is if she is honest and stops minimizing. Offer to talk to her clinicians if she truly cannot be honest.  I would write a letter to the clinicians and show my daughter beforehand.  Often times she too couldn't be honest about how much she was struggling but reading my letter she would often offer suggestions that really clued us all in as to how hard things were for her.

7.  State very clearly what your goals are.  She needs more support and needs more time in residential.  Repeat often and include this in everything you write and every call you make.

8.  Document, document, document and when you are done with that, start over.  Insurance companies want to save money and you need to keep at them with as much proof that your daughter is not doing well at the lower level of treatment.  Make sure you know what her weight and vitals are doing.

9.  Keep clinicians up to date on what you talk to the insurance about.  I met on a weekly basis with the team to share what I was getting and to enable them to help as much as possible.  Be brutally honest with them too about what you see happening, what your daughter has not shared with them and let them help you fight.

10.  Good luck and take care of yourself.  Your daughter is lucky to have you in her corner.  If ever you need help with writing stuff to the insurance, etc. drop me an email. I have a medical background and have fought this battle too many times with my daughter.  I love to help people fight and win [biggrin]
Kali

Avatar / Picture

Moderator
Registered:
Posts: 659
Reply with quote  #27 
Hi Francie,

Sorry that your daughter got moved too quickly. The insurance companies really don't understand this illness and that is _______(fill in bad word of choice).

Since she has Sundays off is it possible for you or your husband to go up and plan to spend those days with her and eat those meals with her? That could cut down on the skipped meals. There are lots of fun things to do in Boston, maybe you could plan some things with her. I don't know what your work situation is but I think you mentioned once that you work from home? Would it be possible for you to go up and stay somewhere in Boston for awhile and have those meals with her that she is skipping during the week? Maybe it is too early for her to be eating on her own. Also let the therapist know when you have a family meeting that she is finding it hard. Perhaps based on that, they can get permission for her to go back to residential? How is she doing with weight restoration?

There is also this option:
http://eatingdisorderspecialists.com/services/meal-support-coaching/

Which I have also considered, and I know they work up in Boston. They have meal coaches who can meet clients for meals, where ever they want, and be additional support. I think it is a really interesting concept. Perhaps if you cannot spend more time up there and the insurance company will not reauthorize more residential stay, your daughter could meet a coach for some meals every week? I spoke with the woman who started this service a couple of years ago and thought it was a great idea.

Our insurance company also told us that our d. would be authorized for 19 days of residential treatment, which was certainly not enough.

Kali

__________________
Food=Love
Francie

Caregiver
Registered:
Posts: 195
Reply with quote  #28 
Hi HateED, mjkz, Kali,
Thank you all for your support and ideas, it is all very helpful.
My h and I will meet by phone with our d and her t in a few hours. My h has planned a very good way of bringing up our d's struggle without embarrassing or 'outing' her, so he will take the lead.

HateED, Lining up the USCD program for yourself and your d sounds like a good idea. We are sort of in the same place at the same time with our d's so we are going through this together. 

Mjkz, Thank you. With your background and your experience you have given me some wonderful ideas to bring to our meeting today and in further conversations with insurance. Do you think it's true that the insurance co would be kinder if we were using a contracted ED facility? 

Kali, we are in Boston for some meals on Sunday, and certainly I can drive up there for some others, but we are still super wimps when it comes to getting her to eat all of her meal and to eat snacks. I'm embarrassed to say that my only way of supporting her during meals is to overeat because I know she doesn't like it when someone eats less than her at meals. So, I have called the service you recommend since I think that is a good idea for us.


__________________

Francie

byebyeED

Caregiver
Registered:
Posts: 18
Reply with quote  #29 
Francie, I'm so sorry you find yourself in this situation.  A couple of things that helped us was to request a case manager through our insurance company.  She was really able to give us suggestions of what to say and do to keep our daughter in treatment as long as she needed.  Another thing that we did was to request an "out for in" (used to be called a single case agreement), which is an agreement with our insurance company that even though our treatment provider was out of network, they treated it as "in network".  We had to have her doctors write a letter, as well as provide proof that what we were doing was necessary.  We wrote a letter too, telling all the treatments that we had tried up to that point.  We were fortunate that our insurance company was agreeable to FBT, and we didn't have as much of a fight as we expected, but we were willing to do whatever we had to to get her the help she needed.  She is thriving now because of it.
mjkz

Avatar / Picture

Caregiver
Registered:
Posts: 1,264
Reply with quote  #30 
Quote:
Do you think it's true that the insurance co would be kinder if we were using a contracted ED facility?


I can honestly say I've not noticed a difference beyond admission.  It is harder to get admitted out of network but insurance seems to be just as stingy and pig headed about length of stay in an in-network as it is with out of network.  My daughter has had more admission than I truly want to count and it has been pretty evenly split between in-network and out.  My experience with fighting with them has been the same.

One thing I have learned is to include all diagnoses besides the ED.  Depression, self injury, suicidal ideation, OCD, etc.  All help with length of stay.  One place my daughter was at, the insurance company gave her a month more due to depression and suicidal ideation rather than anorexia.

Sometimes you have to be creative too.  For instance my daughter is on a Concerta for depression.  Concerta is slow release Ritalin and not FDA approved for depression so when we have to do an prior auth and ask for an exception (which is pretty much 100% of the time because she is over 18 and I guess insurance companies don't realize that people over 18 do have ADHD), we have to make sure we justify that Concerta to help with concentration problems brought about by depression.  The prior auth sails through that way but we can't get it if we list it as an antidepressant.

At one place, my daughter had gained 5 pounds (and she needed about 40 to enter the lowest rung of a health weight range) and the insurance company decided she was okay to be discharged to PHP.  PHP refused to admit her because they knew as we all did that she was not ready and it was going to be a disaster.  My daughter wrote a letter to the insurance company and we included that. She did one heck of a job of listing her treatment goals and the steps she could take only inpatient to reach those.  I don't know if your daughter is in any shape to do that but unfortunately mine never lost the ability to do that even at a low weight.  I think the fact that she could function at such a low weight made getting her to gain so much harder.  Even if you wrote a letter and took direct quotes from what your daughter told you, it can be helpful.  Mine told me point blank at one place if they discharged her, she would kill herself and you better believe that was in my letter and all my phone calls along with a promise of a wrongful death suit if she followed through with it if they discharged her.  It sounds horribly manipulative on one hand but unfortunately needed on the other hand.

Another thing I have found immensely helpful is finding a good case manager at the insurance company.  We had one that we worked with for years and she was so damn good at getting what we needed.  She would send things back to the hospital with "suggestions" for recoding and worked behind the scenes to help.  She talked to my daughter and took her seriously.  A good case manager can be your best friend!!
Francie

Caregiver
Registered:
Posts: 195
Reply with quote  #31 
Mjkz, Your letter above is brilliant, thank you. So helpful. It is interesting that the case manager at our insurance is the one I talked to, but your idea of adding additional diagnoses to her issues (which would be truthful) is a very good idea. Thank you!
__________________

Francie

mjkz

Avatar / Picture

Caregiver
Registered:
Posts: 1,264
Reply with quote  #32 
No problem.  I also emphasized how all the issues needed to be treated at once which could be done on an ED ward but not in general psych because most general units don't do anything much with eating disorders.  We had plenty of factual evidence that treating one diagnosis without treating the others just led to trouble.  I hope you can get them to listen to you and get her more time.
Previous Topic | Next Topic
Print
Reply

Quick Navigation:

Easily create a Forum Website with Website Toolbox.

F.E.A.S.T. Families Empowered and Supporting Treatment of Eating Disorders
is a 501(c)3 charitable organization committed to maintaining the Around the Dinner Table forum as a FREE service for any caregiver of a loved-one with an eating disorder.

P.O. Box 1281 | Warrenton, VA 20188 USA

US +1 855-50-FEAST | Canada +1 647-247-1339 | Australia +61 731886675 | UK +443308280031 

This forum is sponsored by F.E.A.S.T., an organization of parents serving parents and caregivers of patients of all ages with anorexia, bulimia, and other eating disorders. Information and advice given on this forum does not necessarily represent the policy or opinion of F.E.A.S.T. or its volunteers and is meant to support, not replace, professional consultation.

F.E.A.S.T. is registered as a nonprofit organization under section 501(c)(3) of the United States Internal Revenue Code.

Terms of Use | Privacy Policy | Community Rules | Forum Rules | F.E.A.S.T. Principles | YMadmin | WTadmin
Custom Search of F.E.A.S.T. and Forum Content: