Monday, 3 September 2012

Insurance Issues

I was really lucky in that I received treatment for ED in Canada - where I am covered under OHIP for hospital stays. So, in my days in treatment, I did not have to pay for anything. Other people around the world are not so lucky.

In some countries (for example, the UK and the US), there is no healthcare like there is in Canada. Thus, people with eating disorders who choose to go into treatment must pay for it - or use their insurance. The problem is that most insurance companies refuse to cover anorexia nervosa treatment.

If you go to http://www.cbsnews.com/2100-500265_162-2059820.html and http://thinkprogress.org/health/2012/03/06/436763/will-health-reform-provide-coverage-for-eating-disorders/ you'll read about some people's struggles with their insurance companies. What really caught my attention is that some insurance policies do not cover ED treatment because they believe that ED 'is a choice'. You can see why this is unfair and totally incorrect. NO ONE CHOOSES TO HAVE ANOREXIA. It may seem that the victim is choosing, but really, they are controlled by an evil monster who is relentless and makes constant demands. The poor patient is blinded from reality because of changes in the brain and hormones. So, why is insurance not covering this?! It is clearly a mental illness. In fact, anorexia has the highest mortality rate among all psychiatric disorders. There's a fact for insurance companies.

If you read on in the above links, you will also see that some companies do not cover ED because patients do not meet the whole criteria to have an eating disorder. Part of the DSM (Diagnostic and Statistical Manual for Mental Illnesses) says that to be diagnosed with anorexia, the patient needs to have: (these are just two of the criteria) a refusal to maintain weight at a normal range (85%) and loss of menstruation - also known as amenorrhea. My problem with this criteria is that some people with ED are not severely underweight - in fact, you can have anorexia nervosa and starve yourself, but still not look emaciated. Does that mean you aren't ill?! Of course not! And what about the amenorrhea? Well, some people actually still have their periods at low weights - even when they are starving themselves to death. Does this mean that they are not ill? NO!

My hopes is that these criteria will be eliminated from the next DSM. It is not fair that some companies (or even physicians) are not diagnosing and treating several victims of ED simply because they do not meet these points. This is plain wrong and inhumane. If someone is ill, they should be able to get the treatment that they need in order to live normally and happily. And because treatment is so expensive, it is not right that insurance companies are not covering this. In fact, staying for treatment for anorexia for one month in the US is about $30,000! Wow - that is basically how much a new car can cost you. Now imagine paying that for treatment because your insurance company will not recognize your illness. This is not right.

I pray that these companies will learn and see that having an eating disorder IS a mental illness and IS NOT a choice. I want them to realize that just because someone does not look like a skeleton, it does not mean that they do not have ED. I want them to understand that having a period or not having a period is not a reliable indication of anorexia. I want them to see that patients of anorexia are not just ill - they are VICTIMS.

I was a victim of ED too. And I know how it feels to have my illness downplayed by others who think that I can simply ignore ED or 'just eat'. So, to all those insurance companies who do not cover eating disorders....

YOU NEED TO BECOME INFORMED. YOU MAY BE SAVING SOMEONE"S LIFE IF YOU HELP THEM GET TREATMENT.

23 comments:

  1. I think you are looking at it very simplistically. Many Canadians are forced to wait years for treatment or have not success accessing treatment at all.
    The reason you were able to access tx so readily is bc you were actley ill prior to entering IP, also a lot of a persons abilty to access good quality rests on their ability to advocate for themselves. I take it your dad is a clinician of some sort and that likely aided in the process.
    56 pounds that is really something else!! How tall are you? Many people have ED even AN and are not even underweight. Psychiatric care is difficult to access in general for Ontarians

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    Replies
    1. Firstly, I wrote the above blog so that people can see that I was blessed to get care. If you read my entire blog, you would see that I as NOT in treatment for my ED until July - before that I was in the ICU fighting for my life. In Canada, we are democratic, so your alluding to the fact that I got treatment because my father maybe a clinician is purely incorrect. I also said in my blog that many people with ED are not underweight and this is why insurance companies should support them. Please read my blog thoroughly before making a comment. Thank you.

      Delete
    2. Please do not make this negative comments that only stand for your own.
      Any one should admire a hard working girl that is taking on her own to write her own personal ordeal so that many others may benifit .
      Instead of being supportive ,undersatnding and encouraging ,you are shooting her with negative comments that is not less than ED fighting her and others.
      I think you are mentally ill too and you need to seek treatment from your negativity that may have hidden deep into your soul.
      I hope you apologize and at least stop spreading your negativity.
      Marina is admired by all of us and many follwers and she deserves an honour.
      You deserve nothing but shame.
      Please see your psychitrist.

      A thankul mother thanking Marina and proud of her and ashamed of your comments

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    3. If this what you meant,I agree with you.
      School is very physically demanding and needs any one to take care of their bodies and eat more.I suggest to Marina to eat one meal or snack every 2-3 hours to meet the extra demands on her.
      I agree with Marina going to school that she loves and she is excellent at may hasten her complete recovery.
      Trust me I consider Marina now as an expert nurse,skillful therapist and on top a dear friend of mine that I wish to see and meet one day.

      Please (if you let us know your name) send your comments mixed with compassion and kindness that Marina deserves.

      Marina my dear ,There is only few kind people in the whole world ,you are one of them.

      Keep up Marina

      I love you as my daughter

      A thankful mother

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    4. Thankful mother, I want to thank you for all your wonderful comments and support. You are truly a caring and amazing mother. Please keep reading the blog and fighting for your daughter. I admire you very much and I always pray for you. God bless you. I am honoured to have you as a reader and internet-mother!

      Delete
  2. the UK has publicly funded health care including pharmacare

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  3. You are right Marina
    You will never appreciate our health Care till you go and live overseas or you born there like me.
    We are lucky as Canadian

    Mohammed

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    Replies
    1. You are so right Mohammed. We are very lucky indeed to be Canadian!

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  4. You are right ,most insuraance companies do not cover ED and I think may be because of the cost and seriousness of the illness that requires many professionals visits ,programs and so on.They are smart and have statisitics and know how much it cost.

    Sally

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  5. Hi My Love
    I am from US and one year short before becoming a nurse and I know exactly what you mean.You are absolutely right.
    I may add that insurance companies have physicians and consultants and they have all the up to date information but they choose not to cover because of the cost implicated .As you know before you get insurance ,they require full physical exam and they run meticulous testing and asking for all previous records.
    I agree it is unhuman to leave any body struggling alone without help from this killer..

    Every day I love you more and more
    May be one day I come to Canada and at least work together


    Love

    Henry
    Washington ,D C

    ReplyDelete
    Replies
    1. Thank you Henry for always reading the blog and being supportive. You must know from experience since you are from the US. I appreciate all your kindness and comments, and I pray that the Lord may guide you on whatever you decide to do this year.

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  6. Hey Marina
    Another benifit of comlete recovery is all past history and one day forgotten
    Yes said in this blog
    I was ill with ED!!
    I like that and this means at least in your inside you are recovered
    Keep going my dear

    Mary

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    Replies
    1. Thanks Mary! You are right - I like to think that I used to be ill, as I am in now well into recovery. You are so intelligent as you count the benfits of recovery and inform me of them. I appreciate all your support!

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  7. If you see what is happening in middle East ,you will be thankful We live in Canada .
    I am glad that you got into treatment and you are winning the battle against this deadly monster.
    Yoou are right Marina ,insurance company only insure making money not insuring people's care .

    Keep up your blog along with your complete recovery

    Mays

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    Replies
    1. Mays, I am from the Middle East and am aware of what is going on there - you are right, I am VERY thankful that I am in Canada. God bless you!

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  8. Hi Marina.
    Yes We are lucky to have health coverage in Cnada and I am going to inpatient program in 2 weeks and I am happy that I am determind to get completely recovered thanks to your support and encouragement.
    Yes Marina ,imagine if We have to pay ,I think I am for one I would be able to afford even seeing and paying for one visit.

    Anne

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    Replies
    1. Anne, each comment of yours that I read puts a smile on my face. You have become so strong and are winning at recovery! I am thankful that you too are in Canada and will get treatment. You have all my love and support.

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  9. Marina ,
    I have a lot to complain about of the insurance companies.
    I agree with your reply re first comment.I think that person did not read your full story or even one complete blog and just jumping to conclusion.
    Please keep up.
    I respect and love you.

    Jorge

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    Replies
    1. Thank you Jorge. It is very comforting and helpful to have supportive readers like yourself! God bless you!

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  10. Thanks everyone for their sypport. I will be deleting comments that are rude or inappropriate. If you have a problem with my recovery, I am sorry that it is not 'your cup of tea'. But this is not a place for negative comments - this is meant to be a place where people can learn about ED. Thank you.

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    Replies
    1. u tell 'em girl ;)
      girl power!

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  11. Bravo Marina,I amire you all the way .
    I love you with great respect.
    I love your hard work,determination,personality ,maturity,seriousness,and honesty.I heard from people know you that you are very beatiful too.
    Henry

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  12. Hi Marina

    I've been reading some of your entries and I'd like to quickly say that I'm very inspired by your struggle and victory over ED.

    I read this post and thought to suggest to you to check out the ICD-10 (International Classification of Diseases)'s criteria on anorexia... they're much more comprehensive than the DSM's. Also, as a UK resident, I wanted to say that treatment for anorexia IS covered by the NHS, the healthcare system here, but people often choose to go private.

    That said, I can't pretend like I know much about healthcare in other places but I think people do recognize EDs as true illnesses and the stigma is, though slowly, washing away.

    I wish you the very best with your recovery and I pray God strengthens you daily. I'm sure this experience will only help you to flourish as a young woman of Christ.

    With prayers and love x

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