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No Faith in Healthcare Insurance

Every day of last week, I called my health care insurer for assistance and information about obtaining a diagnosis for, what I suspect is, Autism Spectrum Disorder (ASD; Difference; wow.cad.go/nodded/autism/index.tm). Every time I call, I receive different information. Little by little, I suspect I am getting information on how the system works by accretion, but this is a frustratingly impossible way of getting the assistance I need.

I’m not sure why I’m having so much difficulty obtaining a diagnosis. I don’t know if it is because of my age (59), my economic status (broker than the 10 Commandments), or because I am depending on medicaid (www.medicaid.gov/), medical service provider to the financially disadvantaged and disabled. I do know that I have learned an awful lot of how this health care-for-all system is underserving me.

The first time I contacted my health care provider I was told that the County handled all matters dealing with Autism. This is partially true. If you are under the age of 18, you may qualify for services, including assessment and treatment, at one of the Regional Centers in the County. If you are over the are over the age of 18, you must provide evidence of the existence, prior to the age of 18, of a disabling condition, else you will not be served. In fact, you will be spoken to most rudely by the gatekeepers who will not provide any information that might help you on your way.

The next time I contacted my health care provider I was told that matters of Autism were handled through my insurance company’s Mental Health Network. I called them and was provided with the names and phone numbers of 3 providers that I was to call directly and make an appointment to see someone who could supposedly help me. Well, I haven’t received one response from any of the providers I contacted. Wonder what that means?

I have found it very difficult to concentrate and read anything for extended periods of time. I was diagnosed with PTSD (http://ask.healthline.com/health/post-traumatic-stress-disorder#Overview) and saw a counselor through my primary care provider (PCP) for over a year. The health care provider sent a packet of information, including a Member Handbook. I started reading the Handbook and discovered there was an option to get a second opinion if unhappy with a diagnosis provided by the PCP or the Specialist. My primary care physician’s assistant sent me to a psychiatrist who told me (1) that it was not possible to diagnose me because ASD and PTSD symptoms tracked too closely to be separable; (2) that there was no definitive way to diagnose ASD as it is a subjective diagnosis; (3) that her sole function was to dispense drugs; (4) that I was a smart woman who could simply say I had ASD and then google information to treat myself. Imagine my surprise at learning psychiatrists had become nothing more than shills for Big Pharma and that I could just say I had an ASD and that would be good enough to satisfy my need for access to and the support of the Americans with Disabilities Act (ADA; wow.ada.gov/).

I called the health care provider to ask about the second opinion option AND to file a complaint against the psychiatrist who, I felt, wasn’t taking me seriously. I really didn’t appreciate her condescension. The only successful part of this call was that I was able to file the complaint. The other information I was given to put me in touch with another provider came to nought.

The psychiatrist referred me to a clinical social worker for further counseling for the PTSD symptoms. After seeing this clinician a couple of times, she subtly began to discourage me from seeking counseling. She said the clinic was not equipped to dispense long-term care. This was news to me as I had been seeing a therapist in this very same clinic for a year before the healthcare law came into effect. Also, according the the healthcare network, my benefits included unlimited mental health visits. Somewhere there is a disconnection between the network and those providing services.

I was never in favor of this mandatory insurance. Don’t think financially disadvantaged people are getting services for free, either. I received a letter from the State of California that said once I died, they’d come after my “estate” for the cost of all services provided to me after the age of 55. That message was a better deterrent for me continuing to seek care than all the subtle hints given by the therapist or psychiatrist-shill. I haven’t always been financially disadvantaged and I would like to leave something to my offspring when I kick off, but I will limit my use of this “insurance” that fails to meet my needs no matter how many times I call on them for help.

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