F.E.A.S.T's Around The Dinner Table forum

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nerdski
It's early, but we've had a few professionals in our D's residential treatment (we're on the second RES provider) mention that insurance might stop supporting our D if she's at an acceptable weight per insurance requirements, is eating 100% with no purging, and is not admitting suicidal thoughts/plans anymore (criteria used to keep her in 24 hour care).  She's Bulimic and has severe depression.  She says she has strong urges on binging and purging, but is not talking about this or self harm and suicidal thoughts to the professionals.  Her journals just 1 week ago were a mix about not eating anymore and depressive things like "I want to die", "I'm not going to eat", "I'm fat" and "I'm worthless", etc, which all sounds very ED-like to me.  However, with the therapists, all she talks about is depression, not ED.  I may be paranoid but just want to look forward as I feel the professionals might recommend a psychiatric ward over ED treatment and that insurance may support this judgement as well.

We got a week approved in the new RES provider yesterday but the new "team" we met with said this might be a problem.

Has anyone experienced this before?
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Resolute_Dad
I venture to say we have all experienced it, insurance companies will try to cut off coverage before full weight restoration and will rarely use other criteria to support continued hospitalization or residential treatment. My advice - use any excuse. Tell the professionals what your D is saying so that it gets into her chart. Be a squeaky wheel on the urges to purge - insist on the multiple levels of appeal that you have once there is a denial. See if the docs want to tweak meds and use that as an excuse. Try anything and everything.

If the worst happens and you are denied continued res care, if the facility has a day program, they might be willing to keep her in res for the reimbursement of the day program or require you to pay only the difference on the negotiated ins co rate (if you can afford it). As a last resort, you can mount legal challenges, but you have to either do that before they discharge or risk paying out of pocket and suing for reimbursement, which could take years.

It sucks.

E
Dad to 24 yr old D - recent relapse but relieved that she reached out for help.
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YogurtParfait_US
If diaries are reporting such thoughts but she is not reporting them to clinicians, can they ask her about them? Or, is she denying them when asked?

If they do move to switch your daughter to a children's psych ward, can you go to Denver Children's Hospital, which also has an ED unit, so maybe some expertise in ED also?

YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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nerdski
edf100

Our D is not AN she's BN and does not have a weight problem at all.  The insurance company has ED criteria for res care that says she has to be at an unhealthy weight and/or require 24 hour supervision to not binge/purge, and/or needs a high level of care to prevent self harm.  When she doesn't meet these requirements and only shows "depression" symptoms they say she is not an ED candidate for coverage, but a psychiatric ward candidate.
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nerdski
YP

When I say psychiatric ward I mean a facility that treats kids with psychiatric problems not ED.

We know our kid has an ED but the way this is unfolding is that the professionals are labeling her as psychotic, not a kid with an ED and a nasty co-morbid (in our opinion).

This is speculation at this point, but we feel we are heading in this direction, but who knows.  The good news is that she is eating, not purging, and is not talking about suicidal stuff right now.  But at the same time, she is really intelligent and can mask with the best of them.
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YogurtParfait_US
Sigh. Sending warm support!

YP
"Hope is a wonderful thing ... but hope by itself is not enough. Hope is the reason to take action, to make a plan and then to change the plan when it isn’t working - over and over and over again if necessary." Hannah Joseph (Let's Feast Friday Reflection, "Just Keep Going," Friday, March 3rd, 2015)
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biomom
nerdski, does your D know this? Might be incentive for her to be more forthcoming about her actual thoughts and urges. We had the same problem when my D was in residential, she has a hard time asking for help, talking about her feelings or being seen as "needy" or drawing attention to herself, and we found out later that while she was saying she was fine, she was struggling quite a bit and even purging. But of course, insurance pulled the plug, as all her team was saying she seemed to be making great progress and was stable. UGH
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Cherryusa
Nerdski,

We have had the same problem. You must speak up and as bimom has suggested. You may even call the caseworker at the insurance co yourself and discuss this information with them. Needing 24 h monitoring for purging is a criteria for inpatient level of care for Ed. It's not uncommon for kids to cooperate and not express their extreme internal conflicts because it is very very difficult for them and they may want to go home.
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