I am a 45 year old single mother who has had anorexia nervosa that has been inactive for many years until a year ago. I am currently working for a public school and completing a Masters in Counseling. I have always taken care of my family and worked hard to overcome hardships and better my self. I am not one to look for a hand out or to take advantage of the system.
I opted to contract with PacifiCare through my employer. I had previously been with Kaiser, and though I received good care from Kaiser, I really wanted to be able to see my treatment team that I had been receiving care from and paying out of pocket. PacifiCare had contracted with each member of my treatment team.
I made multiple calls to PacifiCare and United Behavioral Health checking to make sure that I would receive the care I needed for my anorexia nervosa. Colorado now has the mental health parity law and anorexia is considered a biologically based disorder. This law states that this disorder must be treated like any physical disease. I was told many times by several different individuals, even a care advocate, that I would receive the appropriate care and that the parity law did apply.
I entered into a treatment center on July 7. I was approved for a partial hospitalization program, which is 11 hours which consists of therapy, 3 meals and 2 snacks that are supported by therapists, and monitoring of physical health. This was appropriate and I was doing well with this treatment. United Behavioral Health dropped my level of care as soon as my weight was at a level at which they felt I was no longer at risk of sudden death. This decision was made even though it went against the recommendations of the treatment center, my physicians, and the treatment guidelines establilshed by the American Psychiatric Association (APA). This decision was appealed several times and is now up for external review.
I was dropped down to the Intensive Outpatient Program, which is only 4 hours a day, which usually consits of one meal and one snack, and either an individual therapy session, psychiatric follow-up, or group therapy. I spoke with my care advocate at United Behavioral Health and she told me that if I was struggling with this level of care, that my providers could ask for more intensive care.instead of being given more IOP days or a higher level of care, I was cut off because I was not participating enough in my treatment. The treatment center made an appeal after finding out that I had gallstones and needed my gallbladder removed, which was the reason I was struggling with my meal plan and continually complaining of being in pain. The appeal was again denied stating that I was non-compliant, despite a document from the surgeon stating that I would definitely be having trouble with eating and pain and would need help with reintroduction to eating my meal plan.
Again, I am appealing this decision while my physical and emotional health is suffering, not to mention the financial and emotional strain this has put on my family. I am continuing my fight with this company and will continue fighting as long as I am able. I want others to be aware of the difficulties I have encountered and also would welcome help from any one who has experience in this area.
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