Rebecca and I fought for my mental health and won!

 

As transparent as I am about the state of my mental health, there’s been something I’ve been keeping from talking/writing about over the past few months that now feels good getting out into the open. For the second time in two years, my insurance company has wanted me to stop taking the main medication that’s played the primary role in keeping me from being depressed and very likely reduces my Anxiety. (A cocktail of other medications works with this anchor drug and lowers my Anxiety significantly more.)

Anyhow, my insurance company wanted me to transition to some other medication that is currently on their formulary to manage my Depression and Anxiety. No guarantees of success, mind you.

While Rebecca and I have fought this fight successfully before, this year’s threatened denial of coverage for my current medication seemed closer to definitive. (I include Rebecca because she’s really been more than an equal partner in this fight. While I became immobilized at the process of appealing to my insurance, Rebecca took this on as a challenge she — oops, I mean we — had to win.) This year we fought for my mental health to the point of an external review.

Just before I went on my vacation to Copenhagen we received a letter noting that we won the appeal (i.e. for at least the next 12 months insurance must cover my current anchor medication).

I share this blog entry for three reasons:

  1. I ask that if you must also go toe-to-toe with your insurance company to maintain your mental health, fight the fight if there’s a chance you can still win. Your health is too important.
  2. Keep a mental health journal. While I think that Rebecca’s argument — which included several parts — won the case, I was able to use Prone to Hope posts to describe how insurance physicians not demand I do something that could very likely put me in a place of considerably worse health.
  3. To thank my wife for being my constant support in achieving and maintaining my mental health throughout our relationship.

I am grateful to Rebecca for crafting the appeal letter that included this argument:

My appeal to physicians reviewing this appeal is perhaps cliche, but I will use it nonetheless: First, do no harm. I will be harmed by having to taper off a medication that is working well for me. I will be asked to go from a place of health and stability to a transition that will certainly bring me pain (actual physical pain) and suffering. I know this to be true because I have made these transitions before, when a medication stopped working for me and I had to transition to a new one. Furthermore, it is not known if the new medication will return me eventually to health and stability. The transition could require attempts at multiple medications and it cannot be known if a medication will be identified that can bring me back to the health and stability I am currently experiencing.

Maintaining my mental health (and winning) feels good.

 

2 Comments

  1. Tracey 10 September 2019 at 7:29 am

    Michael, first, I want to say congratulations to you and Rebecca. This is a life-saving win for you. I can’t emphasize that enough. While I’d like to say more about how wonderful your accomplishment is–because it is, I am so absolutely infuriated to hear that insurance companies have directives like this. I have been off and on a number of medications over the last 7 years, and it has been hell. Right now, I am on a combination that is fine. It’s not perfect, but a tweak in either direction moves me to unacceptable states of existence. I am convinced that bad medical advice from a prior psychiatrist about two medications I was once on worsened my depression and set me back to a state that was far worse than when I first became depressed. It is a hole I am still climbing out of years later. I don’t know if I’m correct in my belief that this drug caused this lasting impact, but it was severe while I was on it. Before having taken it, my depression was rather mild. Since then, it has been more serious and has dramatically altered my life. I never bounced back to the mild depression that I had before the drug. It’s been a long, slow, and challenging recovery, and I am still a long way from where I was before. The reason for this long explanation is that we (all who have taken antidepressants) know all too well that no drug affects anyone remotely the same. The side effects can suck completely, and the direct effects can make day to day behavior management challenging and sometimes impossible and embarrassing. I am shocked and outraged that these medications are being treated as though they are aspirins–that they work on everyone the same. This is like insisting that the sky is orange. That antidepressants are always a gamble is such common knowledge, everyone in the medicine (this includes insurance) profession should know this. While statistics and data can tell us a lot about drugs that are most likely to work, that is nowhere near the same thing as saying that they work on everyone the same. I cannot imagine being told that I have to do something that is going to put me back in a crazy, unstable place, drag me back through yet another round of horrible side effects and might not even work at all by people who have zero stake in my health and wellness and who clearly have no idea the kind of damage they are causing by such blind, arbitrary decisions. All for the belief that they are saving MONEY!!! AARRRGGG!!!!! I’m so glad you shared this. Thank you Michael.

     
  2. Michael Dahl 11 September 2019 at 4:46 am

    Tracey:

    I am both glad and sad that you responded. Sad because you’ve had to endure so much. Glad because you’ve put to words the experience of so many who suffer with Depression and/or Anxiety and who must find the medication (and dosage) that works for them.

    It can be, as you say, hell finding that place. And this is why I have been so angry that a decision was almost made for me by my insurance company, and the decision was not being made for any — ANY! — health reason. “Do this, Michael. Oh, we’re sorry (not) that you’ll now need to spend weeks, months, or even longer finding a happy (or tolerable) place again.”

    As followers of this blog know, my current cocktail of drugs took a very long time to find. First, I had to settle on what I call “my anchor drug,” the one that eventually pulled me out of Depression (but was doing only a little for the Anxiety). Then, I had to find the correct dosage of that drug to actually have its full impact on getting rid of the Depression. While all this was happening, my doctor and I had to test a variety of medications at varying dosages to see if we could ratchet down the Anxiety. And it didn’t take weeks or months; it took over a year for me to find a place of health and stability. Mind you, I still grapple with Anxiety, just much, much less so. I had to make the decision (with my doctor’s help) that the place I landed was where I was okay being for the long term.

    Now, to have my insurance company almost pull the rug out from under me — NO WAY!

    I can’t imagine what I would have done, how I would have felt, if the insurance company had just found me compliant. Weeks, months, or even longer to possibly find that acceptable place again.

    And, again, it must be said, I am so lucky to have Rebecca in my camp. I don’t know how much of the right decision was made because of the role my doctor played in the appeal, because she was certainly also a strong ally in this fight. But Rebecca’s sticktoitiveness and skilled writing and argumentation certainly communicated, “You are NOT going to mess with us.”

    Sending hugs.
    Michael

     

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