Can’t afford treatment, insurance taking forever
Hi all, sorry in advance for the wall of text. Thanks in advance.
I’ve been in mental health treatment for all of my adult life, with things getting much worse recently. In January of this year, it was recommended to me by several doctors & therapists that I try a more intensive form of treatment that is gold-standard for my diagnosis.
Here’s the problem: the only practice in my area that offers such a program does not accept insurance at all. I have no out of network benefits whatsoever. My insurance is employer-sponsored.
I submitted my first superbill to insurance to try my luck, but of course, it was denied (EOB rationale: “This service is not covered. This provider is not participating in the plan's network. Services by non-network providers must be precertified in order to be covered. These services were not precertified. [W77]”). I called the insurance company, who told me to call HR. HR told me I need a letter from the chair of the Department of Behavioral Health at our hospital that the hospital a) doesn’t offer my treatment program and b) the practice I’ve been at is the recommended practice. They also need a letter from the practice with the treatment plan, ICD-10 codes, & CPT codes. I’ve reached out to everyone & the paperwork is apparently in progress. Then, HR will decide if this treatment is clinically necessary.
Since bureaucracy runs slower than molasses in January, I’ve been blowing through my HSA. I have $200 left. Treatment is $275 a week. Today was the last session I could afford.
I will preface this by saying, I do not need mental health advice. This is also a specialized treatment offered by one practice in my region, so “finding a new therapist” isn’t an option.
Prior to all of this, I was drowning in a good day, now I just simply don’t know what to do. Weekly therapy has literally been the only thing keeping me alive for a while. Without continued treatment, I’m afraid things may become life-threatening.
Are there any emergency coverage provisions or funding streams available to hold me over?
What happens if HR decides not to grant the exception?
Any other ideas?
submitted by /u/asilli
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