Maybe Not as Easy as I Thought?

Hopefully I'm overreacting to a letter I got in the mail from the behavioral health (new word for Psychiatric?) facility I'll be visiting. It states, in part:

On behalf of ABC Insurance Company, the Local University Behavioral Health Department determines whether a requested service is medically necessary and covered under your health benefit plan. We have received a request for coverage of Behavioral Health Services with FirstNameLastName, MD.

Your request for behavioral health services has been approved. You are approved for one visit from 11.20.09 to 1.31.10. Please schedule the approved number of visits within this period of time.

LIMITED BENEFIT: Services for behavioral health and alcohol and/or other drug abuse services is a limited benefit; per your schedule of benefit sand Medical Certificate of Coverage, your policy covers the following medically indicated services, up to the limits of the policy outlined below, when services are provided by a participating provider and prior authorized.

It then goes on to list the limitations of my current coverage.

I have a few questions about this...

First, how can they determine whether my requested service is medically necessary before they have me meet with a licensed professional? The person they had me speak with in order to make my appointment asked me maybe 4 or 5 questions. Maybe they thought they had enough information based on my answers, I don't know. {shrug} If it was enough, I can probably pinpoint the answer that did it, but still.

Second, my coverage doesn't require prior authorization to see specialists (members are permitted to self-refer), and nowhere on my Schedule of Benefits does it say that I have to obtain prior authorization to receive behavioral health benefits.

Third, how can it say that I am only approved for one visit between 11/20 and 1/31, when recent amendments to the Mental Health Parity Act go into affect as of 1/1? I suppose as long as my visits/medication are covered, I shouldn't worry too much about it, but the letter gave me a severe case of raised eyebrow.

Oh. And for anyone wondering, this is strictly about behavioral health. I do not abuse drugs or alcohol.

Why I Love The Internet, Reason #24,378

While I am a relative Internet Goddess compared to some, it wasn't always so.

The first time I ever realized I might need help, I was in college. Or, as this blog might imply, it was probably 14th or 15th grade. Before my parents ever got our first computer (let's just say I don't come from a long line of early adopters - my Grandma had a microwave before we did), before I had ever heard of anything resembling "online."

While some of my now-friends were enjoying the explosion of IRC, I was, through no fault of my own, Lily Luddite. All I had were a handful of friends who had no idea how to cope with my moodiness (which was likely chalked up to being stressed at school), my increasing lethargy (a sure effect of my increasing waistline) and my growing anti-socialism and absenteeism (maybe I "just needed a break"). It was a time when I needed real friends and genuine understanding. And while I did have a few friends who were blessedly patient with me, for the most part, I was severely lacking what I truly needed - people who knew what I was going through. One of my professors noticed I wasn't quite myself, or, well, the "self" I'd been, anyway, and pulled me aside one day to recommend I talk to someone.

aside: Dr. Auner, if you ever come across this, I am forever in your debt.

And now? Years later, we have this:

People who KNOW. People who UNDERSTAND. People who are well-known in the blogging community and perhaps the internet as a whole, who are willing to put it all out there for public consumption. Whether their willingness stems from an increased societal understanding, or from the desire to increase societal understanding, they're out there. I know they're there, and it is a great comfort.

Better Late Than Never. I Hope.

At 33 years of age, I still haven't managed to shake the ghosts of my childhood and adolescence. I'm typically able to will myself into denial, but every once in a while - quite often at the worst possible time - they show up to haunt me.

I've been medicated for depression and anxiety, yet have never had proper therapy - but medication can only go so far when one is actively avoiding the issues necessitating said medication.

I've never had insurance that covers more than twenty mental health visits per year. I've been putting off going to therapy because I can't afford to pay out of pocket (and really, who can?).

I've been afraid that I'd start therapy and find it incredibly helpful, only to have it cruelly yanked out from underneath me after visit number twenty.

Thank god for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 - as of January 1st, 2010, I can have all the therapy I want.

The search for peace starts here. Starts now.

Let's hope it's not too late - for me, for my health, for my marriage, for my career, for my ability to have children. Please let it not be too late.