During the past week, which was Mental Illness Awareness Week, and on the cusp of today's World Mental Health Day, I find myself reflecting on how grateful I am for where I am today. That would not have been possible if I had not had access to the intensive treatment I needed for my diagnoses of anorexia, depression, and borderline personality disorder.
The ability to access treatment came from various sources. When I was first hospitalized for anorexia for six months in 1987, it was prior to managed care, so insurance paid without an issue. It was the same circumstance the following year when I relapsed and was re-admitted for four months. Then I was diagnosed with depression and admitted to a day program in New York City, also paid for by insurance. The depression didn’t abate, though, and I attempted suicide and was re-hospitalized. It was during that admission when I was diagnosed with borderline personality disorder and subsequently transferred to a private psychiatric hospital north of New York City which had a long-term unit for individuals diagnosed with BPD. This unit was revolutionary for 1990. The staff treated their patients with a then-new therapy called dialectical behavior therapy (DBT). Insurance paid for me to stay there for 10 months but then balked at paying for additional time.
The staff on the unit believed I was still a danger to myself, though, so the plan was to transfer me to Creedmoor, a state hospital in Queens, NY. My mother stepped in to thwart this plan and a compromise was reached. The insurance agreed to pay for me to live in a 24/7 supervised residence and attend a BPD day program which also specialized in DBT. I attended the day program for 18 months but stayed at the residence for three years.
After I left the day program, I saw, C., the therapist I’d been seeing there in her private practice. An old boss of mine called me asking me if I wanted to work for her, and I accepted. Before I lost my job after the second hospitalization for anorexia, I was a Consumer Promotion Development Manager. This is someone who (prior to the Internet) worked on financial incentives for a product, such as couponing in the free-standing inserts in newspapers, sweepstakes, etc. My old boss worked at one of the largest packaged-goods companies in the world, but after a year the pressure proved too much for me and I left. I recall paying C. out-of-pocket for therapy, but it was a reasonable fee for the time and I was working, so it wasn’t a hardship.
While I was seeing C., I made another suicide attempt and had several more psychiatric hospitalizations, both for depression and my eating disorder. Since I was no longer working, I had to go on Medicaid, but C. didn’t accept Medicaid, so my mother was helping me out. C. encouraged me to return to graduate school and obtain my Master’s degree in Social Work, so by 2002, when my mother passed away, I was working and paying for therapy with C. on my own. I had health insurance, but C. didn’t accept insurance. Starting social workers didn’t make much money in 2000, so therapy was a major expense.
In 2005, I quit therapy with C and stopped all my meds. I’d just had enough. I’d been in therapy for almost 20 years and I wasn’t getting any better. Going off my meds abruptly wasn’t a smart idea, though, and I quickly spiraled into a suicidal depression. I had also been participating in a women’s group and the social worker who led it gave me a referral to a psychiatrist for an evaluation for medication management.
That psychiatrist turned out to be Dr. Lev (not her real name) and that one session for a medication evaluation turned into 11 years of transference-focused psychotherapy (TFP). TFP is an evidence-based treatment for BPD. As Dr. Lev is a psychiatrist and doesn’t accept insurance, you can imagine the sessions were costly. TFP requires two sessions a week. Through a combination of Dr. Lev's generosity — she lowered her fee so I could work with her and at times let me carry a balance, which I always paid back — and that of my brother, who paid for my therapy when I couldn’t, I managed to continue to work with Dr. Lev for the time I needed to recover. I am incredibly grateful to both of them. Our work together saved my life and gave me a life worth living.
What to Do If You Need Insurance Coverage for Therapy Not Covered by Your Insurance
- Ask your insurance company for a peer-to-peer (P2P) review. This is when a doctor (hopefully, a psychiatrist) from your insurance company has a consultation with your psychiatrist. Your psychiatrist explains to the doctor representing the insurance company why the treatment he or she is recommending is 1) medically necessary for you and why 2) you cannot access it from any other provider in your geographic area.
- Request a single-case agreement (SCA). This is if the care that your provider believes is medically necessary is not covered by your plan. (For example, residential treatment for eating disorders is not typically covered by Medicaid.) You are requesting that an exception to your plan benefits be made, due to 1) medical necessity and 2) the fact that none of your covered benefits will provide you with the care you need for this specific condition in your geographical area.