We all know all too well about the failures of the healthcare system in Maine and America.
However, I feel like I only ever hear about MaineCare or the ACA funded insurance. What about if you have work-funded private insurance, like me, on Harvard Pilgrim? That's coverage, right?
I wanted to share my story because I know a lot of people are in the same predicament to me. It’s awful. There was no reason I have to advocate so hard for me to get mental health services and continually hit wall after wall, especially as I deal with mental illnesses and the loss of my entire family at age 25.
In early March, my psychiatric nurse told me she would be leaving her practice in a month. The doctor's office is already brimming with overflowing patients (they accept anyone, regardless of insurance). I began to look for a new provider, thinking that because I had work-issued insurance I pay into weekly, I wouldn’t have a problem.
I began calling who ever I could find on Google or through a few people my psych represented. No go.
Logged on to Harvard’s/Optum’s website for psychiatric care providers. No go. No longer taking new patients or no longer taking Harvard Pilgrim because of their slow, and low, reimbursement rates.
I added my friend onto my insurance to help me advocate; and together we downloaded a list of providers from Harvard’s website. One by one, we called and noted. Most voicemails: No longer taking new patients or no longer taking Harvard Pilgrim. Ones I got on the phone? No more HP, reimbursements take too long and are too slow.
The directory was worthless. Dozens and dozens of phone calls. Nothing.
I tried finding PCP's who might be willing to prescribe for me, including my own, but I'm often seen as "too severe". This phrase bothers me. Shouldn't the "severe" ones come first in help? I feel like this is a death sentence for me.
You might remember me with my “LOOKING FOR A PSYCH” graphics last month. I had dozens of people reaching out to me, recommending names, recommending businesses, everything.
I called. None of them worked out. Instead, I mostly found a community of a lot of people here in Maine, who have insurance, but have lost coverage, especially for mental health care. This worries me, especially the upcoming AHCA, which WON'T discriminate against pre-existing conditions (like mental illnesses) but CAN SURCHARGE and price out people from coverage.
Remember, I started this search of March 2017. On May 5, 2017, I learned from an individual that I’m able to make a claim against my insurance company in the state of Maine for allowing me to lose coverage illegally. A lot of people don’t know this exists.
Where you can file a complaint: http://www.maine.gov/pfr/insurance/eform_chcd.html
** PLEASE MAKE SURE *** To transcribe all phone calls with your insurance and your health care representative to hold on record in case your insurance lies; you may need it to prove your case to your liaison in Augusta.
May 9th, I met my contact in Augusta (virtually) and my insurance company waited to the Deadline of when they had to respond.
May 22. I receive their response from my Augusta contact. Harvard Pilgrim claims to have “no idea” what I’m talking about, even though I've been in daily contact with my "Care Advocates".
As this is all going on, I managed to get a Harvard Pilgrim Care Representative and an Optum Health Care Advocate, who I had been talking to in May to try to find me care. Harvard Pilgrim passed me off very quickly, as they don’t cover psychiatric care, to their leased psychiatric insurance, Optum.
Now, while I’ve had a care advocate in Optum, our phone calls went VERY differently from what the insurance company claimed. They are based out of Indiana, and she was appalled by how I couldn’t find a psychiatrist, psychiatric nurse, or PCP willing to prescribe me medicine in Maine. She called the directory too, no go.
I get passed to her supervisor. Called all the same people again. No go.
In response on May 22, I told my Augusta contact that I felt that they misrepresented the truth. Meanwhile that afternoon, my Optum care advocate called me and I made sure to transcribe the entire conversation (hitting those notes above) and email the transcription to my Augusta contact. That was the key.
Immediately, the state gave my insurance a deadline for finding me out-of-network coverage. My insurance first passed it off to me to “find someone who will take me”. Called Augusta, found out it wasn’t my responsibility. They then called their old out-of-network list: no numbers working, or no longer taking new patients.
Over the past two weeks, they’ve only found me ONE psychiatrist. That was a doozy. He was on vacation for the first week. Then I went to my old psychiatrists office to sign over a release, fax it over, and then found out the new office never received it because they just changed to a new fax machine. Had to sort that out. Psychiatrist came back, but now his secretary’s away for the week at a conference. I had to have my representative call for me to finally book me an appointment, which I got, June 19th next week.
June 19th. Just an assessment, to make sure I’m a good fit for a patient. I started this journey in March. Daily phone calls. Daily emails. Transcribing conversations. All of this, while I’m trying to find psychiatric care and navigate grieving for losing my family at a young age.
Mentally ill people are already at a disadvantage. What happens if people aren’t as strong-willed as me? They just go without care. They go without treatment. We lose people this way. I cry whenever I hear of a case here in Maine, of people trying to find care like me, but end up losing their life while struggling to find that care.
Remember, Emergency Rooms aren’t a fix, they’re just a band-aid. I am tired of the misconception that all you need to do when you are suicidal is to call a hotline, and from that, you will receive the help and care you need. You won’t if you’re poor or your insurance lacks coverage of insurers. (A $3000+ night in the hospital isn’t a replacement for regular care. A doctor is needed to be seen on the regular, or for me, weekly-basis to start out with.)