mental health discrimination??

Discussion in 'I Have a Question...' started by Miss Invisible, Apr 3, 2015.

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  1. Miss Invisible

    Miss Invisible Well-Known Member

    This is kind of an odd question but has anyone experienced discrimination from their insurance carrier once they began mental health services? A sort of bias where they're forced into a restrictive program forcing them into one provider that authorizes everything with the reasoning of overutilization of medical services although no more than 4 visits in 2014 were accessed. Also, the insurance choosing my provider.
    Anyone else that has experienced this or similar to this please advise me. It has only been three visits in 2015 from my therapist along with her official diagnosis of PTSD, then I recieved a notice in the mail. It's very important for me to keep my doctors, due to my level of trauma I cannot have a male doctor and sometimes still have panic attacks at the office I'm comfortable in. I feel discriminated against but maybe I'm wrong, any suggestions?
     
  2. total eclipse

    total eclipse SF Friend Staff Alumni

    i would say that is not up to insurance company who you see You should chose doctor that suits you best It is not right really what they are doing.
     
  3. may71

    may71 Well-Known Member

    Are you in the States? Maybe you could contact your state attorney general's office and file a complaint about an insurance provider.
     
  4. DrownedFishOnFire

    DrownedFishOnFire Quieta non movere

    What insurance company do you use? Does not sound like my norm insurance process.

    Yes you have right to go to doctor of same gender. They cannot do that. Call the insurance company customrt service and maybe get ahold of someone who can change doctor you want maybe they are giving you doctor because you didnt pick one out to them somehow missing a step?
     
  5. NYJmpMaster

    NYJmpMaster Have a question? Message Me Staff Member Forum Owner ADMIN

    All insurance companies (or 99% at least) now have networks of drs. They did this to come into compliance with Obamacare (remember the whole "you can keep your old dr fiasco and following scandal shortly after the program rolled out? ). If you are choosing an out of network Dr there will be far higher co-pays and deductibles if you have any coverage at all with out of network providers until your maximum out of pocket expense is met for the year ( in my case it is $1000 before they pay anything, then a 70/30 split until $5000 out of pocket at which time they cover all again just like in network just as an example). Call your insurance company if it was not explained in the letter and find out what your benefits are.

    In your case with special needs, ask your insurance company about special needs exceptions or a "single use provider agreement". That is how you can appeal to use an out of network Doctor, but that is typically only possible if they do not have the same specialist withing reasonable distance in your network. If you can show medical need like the PTSD that may give some extra help with it but It would be a special exception. The other thing you can do is call your insurance company, explain the situation and ask for a case manager to help you resolve it. They were of some use in helping and most insurance carriers will provide one to help find the care you need withing your plan.
     
  6. Miss Invisible

    Miss Invisible Well-Known Member

    Thank you all for your advice. I'm appealing to the insurance with the help of my therapist and my neurologist in regards to my PTSD diagnosis. My PCP has been less than helpful, refusing any sort of interaction in the appeal. Why, I don't know. Hurtful..yes. This PCP has been my physican for many years, I'm feeling a little let down. She was also my referring physican for specialized care so I'm a bit bewildered.
    I have definitely found helpful suggestions from those responding, so thank you once again. It is very hard not to just give in and believe that I don't deserve the care I'm finally trying to get. You start to think "i never should have tried to get help". In the least, I'm overwhelmed with the stress of wondering if I'm even going to get care.
    Just when I saw my pain clearly, finally made it to a therapist, and actually opened up..there's more red tape. :lock1:
     
  7. may71

    may71 Well-Known Member

    Anything remotely legal tends to scare the crap out of doctors. I wouldn't take it personally
     
  8. AsphyxiateOnMisery

    AsphyxiateOnMisery Well-Known Member

    No you're not wrong. If you're uncomfortable with a male doctor there's no reason you should have to go to one. With my insurance, you have to call them and work with them to pick out a mental health provider. They don't force one on me, but it gives me anxiety having to do that. I don't want to go to just anybody because I've done that already and it didn't do dick for me, but if I get too picky with the things they suggest to me over the phone I can tell they start getting annoyed in turn making me socially anxious, I don't do too well with that, let alone the fact that I'm nervous enough about making phone calls in the first place. So yeah, I feel discriminated against too for having to do it that way every time.
     
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