Posts Tagged: Insurance and Benefits

At Long Last, Caremark Delivers

To those of you who followed my Caremark rants over the past two years, don’t gasp in shock, but I just got approval for Sticks’ meds after three years of paying for them. I have no idea what’s different today than three years ago, but I’m not lookin’ a gift prior authorization in the mouth. Just being grateful.

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My take on “Sicko”

I’ve posted it on the political blog here.  I hope you’ll read it and pass it along to others. 

I cannot say this enough — this is a film with which you may or may not agree, but you will THINK.  And thinking may just be the beginning of a conversation that takes us somewhere.

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Mental Health Is the Center of VA Tech Tragedy, Not Guns

This isn’t a gun control post. Don’t come here and comment on gun control issues because there’s plenty of places out there to do that. This post is about the failure of our mental health system to adequately treat someone who was described in 2005 as “mentally ill and in need of hospitalization, and presents an imminent danger to self or others as a result of mental illness”. It touches on politics because our government has inserted itself so deeply into our health care system. It grabs at me because I have to navigate that system each and every month in order to get the treatment necessary for Sticks’ and my ADHD.

Alexandra Zacharios-Haight writes:

Whether Cho Seung-Hui was ignored my his fellow students and faculty experiencing what Durkheim called anomie; was lonely, depressed and totally untreated; given psychotropic medication only and poorly monitored; not seen frequently enough by a culturally sensitive, experienced clinician (campuses often don’t make it a priority to employ the best and the brightest and kids and their parents often can’t afford better because insurance won’t pay)–one thing is clear there were signs that something was terribly wrong and these signs were not be dealt with adequately.

Establishing a therapeutic alliance (an authentic relationship) between patient and clinician is what determines outcome. Government, insurance companies and naïve laypersons who want to dictate policy, procedure and treatment need to get out of the way because there are lives to save.

Indeed. But what happened in Virginia happens every day. It is why there’s an epidemic of homeless, mentally ill people wandering the streets at night, seeking shelter, needing treatment. It happens to university students, to respectable young men and women who are at a critical juncture in their lives. It happened to a dear friend’s son. He won a full scholarship to a prestigious university and went off to college, where he began to slowly have a breakdown. His parents were unable to intervene because of HIPAA and his refusal to allow them access to his records. They tried and they tried and they tried to get him public assistance, but there was precious little available and by the time they were able to intervene at all, he had dropped out of school and was sleeping in his car, unwilling to receive the meager assistance available to him.

Ultimately it took jail and a sentence that included mandatory treatment in order for him to get the medication and therapy he needed. Think about that. To receive treatment for his illness he had to become a criminal. That’s wrong.

Deborah Lynn writes:

Usually the insurance companies find a way to either stall payments, or make it incredibly difficult for any normal person to figure out how to get insurance to cover mental health situations. The parents then either ignore the problem or hope that the mental health services in college will catch their child if he or she falls ill. All this systemic inadequacy must stop. The stakes are too high to be screwing around with the mental health of our kids.

Sound familiar? It should, particularly the part about getting insurance to cover mental health situations and then hoping they’ll get caught in college. It’s really time to let go of this.

Mental illness is an ILLNESS. It is an illness, and a chronic illness. It is treatable. It is as serious as cancer, or HIV, or diabetes or heart disease. But it is treatable. Let’s stop worrying about stigma and start worrying about treatment.

Cho was put on a brief hold, given medication with no follow-through, and released. Because he agreed to the hold voluntarily, there was no record of it when he purchased the guns and therefore no alert to the seller of the guns that he should not sell them. To him, it was a normal, everyday transaction. Everything was in compliance. There should have been a record of it. Why does it matter if his hold was voluntary? He was reported as being a danger to himself and others, and that record should have been part of the database that gun merchant checked.

The other theme running through this tragedy is whether the university did everything they could when his behavior raised flags. I’d say they went beyond the norm with him. In a university that size, to have the head of a department take on personal tutoring to assist him with his education is amazing to me. They certainly didn’t have the information to know that he was a danger to others, but were willing to make accommodations so that other students would not feel uncomfortable around him and he could still continue. I was truly amazed by how involved they were in trying to ensure that other students would be in a safe learning environment while helping him at the same time.

If we take away one lesson from this, let’s make it this one: There is a real need in this country to give serious attention to how mental illness is regarded and treated. We need mechanisms in place — safety latches — to assist people through whatever journey they are on emotionally. It cannot be done on daytime talk shows with panelists Tom Cruise and Dr. Phil opposing. It needs to be a part of the dialogue concerning healthcare in this country, how we handle privacy issues, and how we address cases where the illness causes the person to turn away from necessary treatment.

On a personal note, this is of concern to me because of the ADHD. Sticks has succeeded because he has been successfully treated. I will not have the same involvement in that treatment at this time next year. i think he will continue as he has. But I cannot be sure, and I know what kind of havoc can be wreaked with untreated ADHD.

There’s a reason I’m not a college graduate. Figure out what it might be.

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