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A Fantasy Letter to Our Insurer Upon Receiving the Final Denial of Our Appeal

Suzanne Oliver

Dear Insurer: 

I can’t stop thinking about you and the contract you have broken with our family.  After years of forthright service - covering the deliveries of our three children, reimbursing us for their vaccinations, paying for x-rays, strep tests, and the setting of broken bones – you have abandoned us in our daughter’s struggle with an eating disorder, the deadliest of mental illnesses.   Contrary to all concerns for her long-term health (and your long-term expenses), you pulled out at the very budding of her recovery with the most flippant and self-contradictory of responses to our final appeal: “The member could have continued therapy in other settings and there are no significant behavioral problems reported.”   

What?  Why move to a new setting when this one, which you previously approved, is working?  And did you read the medical record and the treatment notes?  They contained the documentation you seek.  And then you ended the letter with the following: “This determination does not mean that you do not require additional health care, or that you need to be discharged. Decisions about continuation of treatment should be made by you and your provider.”   Well, both she and her provider unequivocally reported that the treatment should continue.  The provider supplied you with treatment notes that conform to APA – and your own – guidelines, providing evidence that this care is a medical necessity.  Your judgment is loud and clear: a mental disorder does not deserve the same attention as a physical disorder.  

At first, dear insurer, you bullied me into believing that you were right. That perhaps my daughter and her illness were not worthy of so many hours of therapy and therapeutic attention.  But then, I saw her change with the therapy. I saw her behavior, her physical health, and her mood improve. I listened to her share her developing insight, hope, and deep desire for recovery.  I saw her become a young woman with a future, not just a girl with a disordered past. This transformation was something that four years of outpatient therapy had not accomplished.  

Thanks to the NEDA website, I learned that the law is on my daughter’s side, even if you are not, dear insurer.  I listened to the insurance webinar of Dawn Lee Akers and learned about mental health parity. I’ve read our insurance contract and believe that you have acted in bad faith.  Having exhausted our internal appeals with you, we are now resorting to legal means to force you to honor your part of our insurance contract. The office of our state attorney general is reviewing our complaint against you.  

We are lucky. Even though you pulled out, we were able to continue to pay for our daughter’s care.  She is doing great, thanks for asking!  In fact, she will soon be discharged.   You see, she wanted to do this right.  She doesn’t want to go back to treatment any more than a cancer patient wants to go back for more chemo or an organ transplant recipient wants a new organ to fail.  Some people’s bodies malfunction. Some people’s brains malfunction.  They both need intensive interventions and rehabilitation to ensure a sustained recovery.  I know we are lucky to have had the wherewithal to continue our daughter’s treatment.  You may have hoped we would have given up and saved you some money.  We didn’t. The unfortunate fact is that we had to keep spending money on our daughter’s treatment in order to have a case against you.   That is an unfair system. I mourn for all the ED sufferers who cannot continue to pay when you bow out.  How much longer, I wonder, does it take them to regain a life without the mental anguish of an eating disorder?  

Every person with an eating disorder deserves treatment through recovery.    That means a recovery in physical health, emotional health, and behavior.  All are medically necessary.  Stop trying to argue your way out of your obligations before that holistic recovery is achieved. 

Sincerely, 

A. Disappointed Parent 

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