Beyond Blue

Beyond Blue

Borchard vs. CareLast

If a person weren’t mentally ill before dealing with health insurance companies about her mental health benefits, she surely would be after a phone call or two. Marbles start rolling out of the noggin a second after the back-stabbing representative asks you, “How may I help you today?” (as if she means it).
I’m now convinced that when Jesus instructed his disciples to pray for their enemies, he wasn’t referring to the loud neighbors with the yappy dog who craps on our lawn, or to Bush’s axis of evil. He had health insurance companies in mind.
I have been praying for CareFirst (a.k.a PayFirst CareLast) every day this week–almost hourly since I received a bill from Laurel Regional Hospital for $2,600, half of the cost of my outpatient treatment program almost two years ago. (That’s right, Sept. of 2005)
This disturbs me on several levels.
First, of course, is the whole philosophy about mental illness held by most health insurance companies; they are a larger, more bureaucratic, corporate, and criminal version of my friend Eileen, who swears that I am fabricating this whole “brain disease” stuff, and that anyone who suffers emotionally or mentally is a weak pansy who has certainly attracted it to herself by poor stress management. (“We are all dealt a share of life’s blows … get over it!”). I can forgive Eileen because I know that she doesn’t get out much and she’s been taught all she knows by some very ignorant but extremely persuasive teachers (which are plentiful today).


Health insurance companies, however, have read the same studies about depression as I have: that by using high tech brain-imaging methods, researches have been able to identify a number of regions in the brain, like Area 25, that malfunction in major depression; the refinements in brain-imaging technology today make it possible to show how the regional patterns of brain activity in a depressed brain differs from the activity in a non-depressed brain. Not to mention all the research into the genetics of mood disorders that can identify certain genes that predispose persons to mental illness.
Eric and I shelled out over $25,000 in healthcare costs/insurance premiums last year. We cashed out part of our retirement savings to pay for the Johns Hopkins bill ($8,500), even though we were told that it would be fully covered by insurance since I was admitted as emergency status. I paid (and continue to pay) for all of my psychiatrist visits out of pocket. And our insurance premiums run us about $1,000 per month.
Two years ago, I received a bill from Laurel Hospital for $5,500 to cover my four-day inpatient stay. This was after a nurse put her arm around me (she knew I was nervous that my stay wouldn’t be covered) and said, “We wouldn’t have admitted you if it wasn’t going to be covered. We’ve talked to your insurance company, and you’re good for up to five days, and for several weeks of outpatient care after that.”
A letter from Magellan, the mental health part of CareFirst, assured me that everything would be covered by CareFirst, and could I please fill out a survey on customer satisfaction.
All told, I spent more than 60 hours (plus sweat, energy, tears, and frustration) while in a very frail mental state arguing my case–copying explanations of benefits, procuring letters from evaluating physicians, requesting records from all practitioners involved–providing all the evidence I needed to hold CareFirst to their word. They finally gave in and paid the bill.
Now, two years later, I have to go to war again. I’m seriously considering litigation because I’d rather pay my lawyer friends $2,600 than the hospital, for a bill that CareFirst assured me that they’d pay.
Sometimes I wonder if they take advantage of persons suffering from mood and personality disorders because they know that these people are often too depressed or anxious while undergoing psychiatric treatment to assert themselves and bring out the mental and legal ammunition that is needed to fight for the benefits that were promised but ultimately denied.
The last time I was this angry, I ratted out a priest in college for making young women feel uncomfortable in counseling sessions and in confession. I submitted a 40-page report, a compilation of my evidence, to get his butt kicked off the campus for good. Fete accompli.
It felt good. Because I turned my anger into action. I think I may have to do the same with these healthcare crooks.

  • Sandy Slaga

    This BS is enough to make me want to get licensed in Maryland to fight the SOBs for you!

  • Babs

    Hard to know which to tackle first — your “friend” Eileen, or CareLast. I’ll start with Eileen: “my friend Eileen, who swears that I am fabricating this whole “brain disease” stuff, and that anyone who suffers emotionally or mentally is a weak pansy who has certainly attracted it to herself by poor stress management. (“We are all dealt a share of life’s blows … get over it!”). Charitably, I would say that people like this woman are actually scared — more scared than we are of being vulnerable, or dependent, or facing their own problems. How much easier to label everyone who wrestles with emotional problems a pansy, than just to listen to a friend, for Pete’s sake. Methinks this woman is content to have everyone around her independent so she can get on with her life. I guess she thinks that abused children attract emotional problems or don’t manage stress well.
    As far as CareLast, several years ago I did not get billed for some cancer surgery for over a year. I think the bill was going to be around $19,000. The hospital was UVa, and after waiting with dread for the bill, we were notified by the insurance company that it was cancelled because UVa did not supply the needed information to bill in compliance with their agreement with the insurance company. That was it — gone. A few years ago I kept getting bills from our local hospital for a procedure. Each time I got a bill, I saw that insurance had turned it down. It took several contacts with the hospital, and finally the insurance company going to bat, to get the matter straightened out. It turns out that the hospital had never furnished the results of some tests to insurance. By that time, the matter had been turned over to a collection agency. But in the end, the bill was adjusted, the bill collectors notified and the matter was settled. In that case, it was the insurance company throwing its weight around to help me. I carefully documented every conversation, both with the hospital and the insurance company. That, really helped.
    I think that given your zero balance statements and the length of time involved, I would write the Maryland Board of Insurance (or some such name as that), and furnish all the information you can to support your case. I doubt that merely informing you over the phone about how they interpret your policy would carry as much weight as those statements, especially given the time that has passed. I’d also contact the hospital and see if they have any correspondance on your case.
    Good luck. It will take time to straighten this out, but persistence seems to win out, though given the high amount of premiums, it would be nice to think we wouldn’t have to go through all this.

  • Robin

    I’ve said it before and I’ll say it again – BRAVO!! BRAVO!! BRAVO!! We must NOT give in or give up – praying for them is a start, but unfortunately – the fight must be fought!!
    Bravo and good will and blessings (don’t believe in luck!!),

  • Blanche

    I was authorized four nights in inpatient, and 8 PARTIAL HOSPITAL visits, I was told. 5 months later, I went back in for 3 days and was told authorized. A month later, I recd a letter from facility that I used up my 20 “outpatient” visits, and I owe them $11,000+. I just returned to work part time for 2 wks, and I needed this like a hole in the head.
    You can be sure I’ll be making phone calls, and possibily writing to my state’s Commisioner of Insurance.
    My prayers for your success.

  • Pingback: On Praying Imperfectly « Therese J. Borchard

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