THE BLOG

Fighting the Beast: Is The Cost Of Getting Sane Driving You Crazy Too?

05/20/2014 07:30 pm ET | Updated Jul 20, 2014
  • K Activist, writer, and parent.
Shutterstock / Stokkete

I am writing anonymously to protect my daughter. She is mentally ill at the moment and suffers from, among other things, depression. I take no chances. I also won't name the corporation that is driving me insane. I am afraid of it. I'm sure it's much the same as all the others anyhow.

I'll call it "The Beast."

My daughter is in her twenties. She is often afraid to go outside. She cannot work. She has lost most of her friends. She hasn't had a boyfriend in years. Will she get better? Better enough? Entirely better? In the middle of the night I wake up and think, "What will happen when I die and can no longer support her? Will she become homeless? Will she become a junky? A prostitute?" And, of course, hanging over everything is the worst of all possibilities. Why hasn't she called today? Is she still alive?

If I had to pick a single word to describe my state of mind it would be dread. If I could add a second word it would be hope. I'd use the word dread to describe how I feel about The Beast, too, though hope would not be the second word.

My relationship with The Beast is oddly similar to the one I have with my daughter. It just lacks all the good bits. As with her, I constantly wonder why it behaves so erratically. Why does it hide from me? It babbles jargon, it makes no sense. When it obstructs me, I suffer as I do when my daughter won't pick up the phone. I have hope for my daughter, I'm not so sure about The Beast.

The Beast is a health insurance company.

My daughter has been seeing a psychiatrist for a couple of years. She speaks of her visits to this man as you or I might speak of water or food. She never misses a session. She is never late. It is the one absolutely fixed thing in her life. It is what holds her together. Because of it, her medication has been reduced. She is brilliant and kind and original. She has a lot to contribute.

And she wants to get better. This is why we have hope.

She should see her psychiatrist more often, but The Beast won't allow it. He (I'll deem it male as few women would be this cruel) only picks up 70% of what he thinks a psychiatrist should get. It is far less than the actual fee and fluctuates as inexplicably as my daughter's moods. At best, the payments have little connection to reality. Usually it's less than half the fee.

One day, The Beast starts arbitrarily denying payments altogether. Nothing significant has changed. My daughter is slowly getting better, but her problems are complicated. The denials come in the form of EOBs (Explanation Of Benefits). There are no benefits and, actually, no reasonable explanations either. We fight as best we can. The Beast pays - or doesn't. There is no logic. The Beast becomes a second cause of stress and perplexity in my already stressed and perplexing life, an amplification of my parental bewilderment, an expansion of my mystification and fear.

Have you read "The Castle" by Franz Kafka? It's about a man struggling with an unreachable bureaucracy. Given what we endure today, the book now seems almost quaint: no automated phone systems, no "do-not-reply-to-this-email" emails, no global corporations. K, the main character in "The Castle," manages to come face to face with some officials, even if they're useless and obstructive. I have no such luck. My Beast lurks in his Castle, completely unreachable. The phone system is a labyrinth of choices that sends you back to where you began. Responses to emails, if they come at all, take weeks, sometimes months. When replies do come, they are surly, perfunctory, enigmatic, or weird. Doors are slammed in my face by an unseen hand. For all I know, the hand is in India.

In a long life, I have never met any entity as gifted in the art of complication as The Beast. The simplest adjustment, the smallest change, the slightest concession must be achieved at the greatest expense of time and effort, with the maximum waste of paper and jargon, faxes, cryptic diagnostic codes, emails, surrogates, and blame. Sometimes The Beast takes so long to reimburse us that we have to use credit cards to pay the doctor so our daughter can continue her treatment, this lifeline, this mental I.V. Sometimes we can't pay the cards and get penalized with higher interest rates.

I am not a businessman or a lawyer. I suppose I must be naïve, or made naïve by desperation. I pay for insurance when I am in good health believing that when I'm not, or when my family isn't, we'll be protected. Every interaction, however, or attempted interaction, makes us feel like beggars seeking something undeserved. Even when it's clear The Beast must pay and eventually does, he holds back as long as possible. Instead of insuring us, he ensures only that we are always on edge. More than three quarters of our daughter's bills have to be fought over, probably more. But perhaps you'll understand this better if I share a few specifics.

It is mid May of 2014 and I am looking at a payment we just received for a single session in October of 2012. Two weeks ago, The Beast denied any payment whatsoever for every session between early November of 2013 and late January of 2014. Shortly before that, The Beast decided he'd been underpaying the psychiatrist and sent a compensatory check for a few sessions from six months ago. Then went back to paying what he paid before, or less. Two days ago, we received a letter denying all payments for the last three months. We have now paid six months of psychiatrist fees and received nothing. We are several thousand dollars out. Worse is yet to come as you will soon see.

It takes us a year or two, but eventually we realize The Beast is not incompetent at all. Far from it. Not paying us is not a mistake, it's the definition of success. The mantra of the business is "deny, delay, defend." If you can get away with it, avoid paying the policy-holder, even if he or she is mentally ill. Deny at first, delay if that fails. If the claimant keeps on coming, still don't pay. Instead, spend the money on lawyers who'll defend against the claim for as long as possible. Even if the company loses, it wins. Plaintiffs and lawyers get frightened off by the enormous amount of time and money the winning plaintiff had to expend to get justice.

During every phase of these many forms of denial, The Beast earns interest on the money he owes. Morality aside, the triple-d strategy works. According to the Department of the Treasury's Annual Report on the Insurance Industry, by the end of 2012, the U.S. insurance industry had $7.3 trillion in assets. Accordingly, the CEOs of the top insurance companies are rewarded with salaries and benefits going from 12 million dollars a year at the low end to total compensation packages of over 40 million at the top end.

Like so many others, this is a scandal-in-plain-sight. Though almost everyone suffers, almost no one is outraged. The very word "insurance" acts like a narcotic. There are no charismatic sharks here like Bernie Madoff or (fictionally) Gordon Gekko. There's no glamor. Sad, vulnerable people get robbed on a daily basis by thousands of bureaucratic "deniers" and "delayers" who are themselves ordinary people trying to feed their families. The CEOs must think these millions of sordid petty crimes against the weak are an acceptable way of doing business, but they look just like ordinary dull rich people who play golf and give to charity. Look, they're smiling! How could they possibly be sociopaths?

When we finally understand just how cynical The Beast was, my wife and I become depressed. How can we possibly fight this thing that lives by such different rules? But after a few days, we realize we have another card to play, a possible friend. I don't know why I hadn't thought of this before, but I am a member of a union. It is the union that contracts with The Beast to provide insurance to its members.

I love my union. I have been paying into it - happily - for years and in return it has defended and supported me in many, many ways. Among other things, it created a pension plan for me, something I'd never have done on my own. My gratitude to it and to the people who work there is beyond expression. As much as I hate The Beast and his cold greed, I love this union of humans formed solely to aid and empower each other. So my wife and I call it to explain the situation and ask for help.

We reach real people! And yes, they say, they can help us! They are good, kind people with real voices! They seem exhausted, overextended, but they are on our side. Sometimes, I catch a note of panic in a union voice; of frustration, of perplexity. Over time, several of them try, and in the beginning succeed, in extracting payments from The Beast. They are still trying.

Or so I thought.

A month ago, my daughter's psychiatrist received a letter on union stationary. I have it in front of me now. The letter includes remarks on dentistry, which seems a little odd, but the rest of it is aimed squarely at my daughter's brain, albeit in broad, crude, bureaucratic terms. An "Independent Medical Consultant," it declares, has decided my daughter's treatment is no longer "medically necessary."

No more sessions will be paid for.

The letter concludes by saying that if we have any "questions or concerns" we should contact the Medical Review Department at the number listed below. No phone number is listed below. The letter is signed, but no name is typed below the unreadable signature.

A new relationship characterized by uncertainty begins. Is this letter really from my beloved union, or is the union just conveying an edict from The Beast? I feel compelled to ask someone at the guild to describe the processes and calculations that brought about this chilly termination. Who is this "Independent Medical Consultant" who has never met my daughter for a second, but now diagnoses her as cured? How? If only. She is alive, but by no stretch of the imagination could you say she's well.

I call the union. I am told someone will call me back. A week passes. I receive no call. The fear and helplessness I now feel is worse than before. The punch you don't see coming, the one from your smiling friend, hurts most, is most shocking. This is a relationship I care about.

It's hard to sleep. Nightmares wake us at three a.m. It becomes so painful, so wearing, so demoralizing, my spouse starts seeing a psychiatrist. What a perfect microcosm of the American healthcare system: a secretive, amoral, paranoia-inducing bureaucratic monster beyond the imagination of Kafka and Orwell combined, denies payment to an unbalanced child and drives her parents crazy - and then has to pay for treatment! Yes, The Beast is picking up the tab, at least for now. A new diagnosis needs to be added to the Diagnostic and Statistical Manual of Mental Disorders: Insanity Caused by Health Insurance Company (ICHIC) or, as The Beast would doubtless put it in his obfuscating, human-obliterating way: 308.3-ultra.

Perhaps this is the problem: even I joke about mental illness. The brain's diseases may be physical - at least no one disputes genetic inheritance - but the organ itself is still mysterious. We imbue it with mystical qualities, we talk of the "mind" as if it exists outside of science. Not understanding it as well as other organs, we suppose that its diseases cannot be correctly diagnosed or effectively treated.

If physical illness hobbled and confined my child in as many ways as her mental one does, would anyone question her need for treatment? Would The Beast toy with someone getting chemo? Pay a little, withhold, delay, then threaten to stop paying altogether? Maybe, but it would be harder to defend. The Mental Health Parity and Addiction Equity Act of 2008 required that treatment for mental illness and addiction be "no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits." I don't know if the law still exists or has been folded into Obamacare. I don't know if my insurance company or my union is breaking the law, but I do know that the arguments I'm having, and the letters I have in front of me would not even exist if we were talking about a broken foot...

I am aware of the undermining affect of hyperbole and hysteria, but I will admit, with embarrassment at the overblown comparison, that sometimes I think of Joseph Welch confronting the powerful, red-baiting, life-ruining, hitherto unaccountable Joe McCarthy: "Until this moment, Senator, I think I have never really gauged your cruelty or recklessness... Have you no sense of decency, sir? At long last, have you left no sense of decency?" I imagine myself as Welch and The Beast as McCarthy, sweating before me. I imagine myself as a lawyer heading up a huge class action lawsuit asking the Beast and his friends for the return of interest "stolen" from policy-holders by denying and delaying benefits; compensation for earnings lost to hours - days - of begging for benefits that are legally due; and massive punitive damages for discrimination against the mentally ill.

To trick the physically sick out of benefits is bad enough. To use the strategies of "deny, delay, defend" against the mentally ill - who are already confused, anxious, and depressed - could stand as the enduring definition of reckless bullying.

If the cost of getting sane is driving you crazy too, please share your story below.

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