My Experience with New Health Insurance…

posted in: Bipolar disorder, Mental Health | 13

I am not whining tonight just wanted to update you guys, since I posted about having to get a new psychiatrist for my girls with the new  HMO health carrier (Health Management Organization).  There are two doctors to choose from, really 2 for this entire area??  

I was forced to go to a parent orientation at this HMO, it was a complete waste of time. Then I have to go back upstairs to turn in the huge stack of paperwork I had to fill out for each child. There, I am told the kids have to see a therapist first before they will set an appointment with a psychiatrist.  I said, “Oh no that’s not happening. My kids have been in treatment for years and need to see a psychiatrist and I cannot afford to spend money on therapy at this point.”

The nice woman behind the counter says, “Well I don”t make the rules.”  So I explained we really don’t fit into this system of theirs as the kids have been established in care for a long time, one of them over 10 years and they need to be seen by a psychiatrist and medications refilled.  So after some time repeating my self this nice woman said she would talk to the administrator. Walked away within range for me to see her and walks back and says she can put in a note to talk to the chief of pediatrics to see if they can make an exception.  She said they would be calling me in a week or so… I thanked her and walked away shaking my head.  I will not be forced to spend money to see a therapist when that’s not what we need. If its required they better waive the co pay!!  Good luck right… Hehe  Yesterday when I arrived home I called my ex and told him he better be ready to get on the phone with these people, since this was his choice he is going to get me what we need. He is all confused because he never listens to me.

Get this… Today he shows up with a print out of one of the two doctors we have to choose from and tells me this is how it works, you have to go in for an evaluation by a therapist. I said, “I can’t pay for a therapist and a psychiatrist and I need medication refilled.”  He got nasty and said I’m just trying to tell you how it works. I said, “I know how it works but it doesn’t fit our situation.” He argued and I said, “did they call you?”  He said, “NO!!”  That nasty tone was enough for me so I turned to walk away and he yells out, “Do you want to know about the prescriptions or are you just going to be a bitch!  Yep he said it… Needless to say my reaction was not pleasant.. I told him what I thought of him and went into the house.

Does he really think he can come to my house and talk to me like that… I have already discussed this with him and the insurance company yet he is a jerk to me.  He acts like I never spoke to him.  You know why?, because when I call him to discuss stuff he hands the phone off to his wife while im talking  and then when I need a response he takes the phone back… There are always long pauses and his responses are always general and sometimes don’t fit the conversation.  Sorry for this but What a dumb-ass! 

Anyway, I am now mad at him and waiting for the HMO to call me back about getting the kids to the type of doctor they need, and not jump through hoops.

I am not whining honestly this is just part of life but thought Maybe I would update you all about how its going… or not going! :)  I suggest if you have a choice of insurance carriers and you need specialized care of any type, don’t go with a HMO. It might be cheaper but you get what you pay for.  :)


One way to get the most out of life is
to look upon it as an adventure. ~William Feather

Image: Ambro /

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13 Responses

  1. What a mess. It’s terrible when they are so inflexible. I know it’s the rules but you would think that in certain cases that they could take circumstances into account.

    • Well im posed to fight it out so thats what I will do.. LOL If they have to see a therapist their dad can pay for it since this was his choice.. big terd.. LMAO It will work out in the end im sure of it but mean time I will try to handle it..

  2. Ugh! So ridiculous. Blows my mind that your ex is clueless and apparently so are in the insurance company!

    • Its amazing to me.. Why do they need to be assessed by a Therapist no less.. They aren’t medical doctors.. Ik they are educated but not what we need.. My kids have diagnosis that needs treating period.. Amazing to me really but not a shock that’s why we never had this type of insurance.. but its cheaper so their dad can save some money.. haha I hope you are well sweetie.. I haven’t been online much the last two days too much going on.. Going to try to today..:)

  3. Wow, how frustrating!! I never had a good experience with HMO’s…and your ex…I’ll refrain from saying what I think of him, but it’s not very nice.
    Hang in there…

  4. Oh I remember those days before the kids were grown. Hang in there and don’t give up until somone gives you what you need!

    • Oh thank you… I will hang in there and be persistent… I will fight for the kids just like im sure you and any other parent would.. Hope you are having a great day and have a good weekend as well.. :)

  5. Oh and remember… you don’t ‘whine’ Shauna! You are just telling us how it is. What gets me most is, even though you have health issues yourself, is that most of the hassle you get in life is from other’s. If I hadn’t known you personally for so long I’d almost think it was made up. It’s unbelievable how others go on and it’s so unnecessary. Hang in there, you are a loving and caring person and mom. I’m just so glad that you have Carl now as you deserve a decent and caring man.

    • Aww thanks sonya for making me tear up again! :) I guess I never realized other peoples lives are not like mine. It’s been this way forever.. But Carl is a ray of sunshine that keeps me smiling.. and So are you! Our friendship over the last three years has meant the world to me.. Thank you doesn’t begin to cover it.. but its all I have!! I have always wanted to help others and it seems sometimes that comes with some dumping on but I am like the energizer bunny I just keep going and going and going… :) LOL Hugs to you!!

  6. Heartbreaking along with frustrating, no doubt!! And by the way, even if you were ‘whining’ about your current situation, who’s to blame you?! Certainly no one, gawd forbid should someone else find themselves in a similar situation. Serious, I really believe that one should be able to speak our mind as we choose, even if our voice shakes from time to time. We all do it! And we all need too!

    • Thank you sir.. I appreciate your words… Your right we all need to be able to speak our mind and that’s really the intent of my blog.. Thanks for reminding me of that!

  7. Some swing in the trees while others should be swinging under them! I’ll just leave my comment at that regarding the lack of common sense and sound reasoning of certain individual(s). Uuugh! You are a good mommy! Remember, our courage doesn’t always roar aloud. Sometimes it’s the quiet voice at the end of the day whispering, “I will try again tomorrow.” So stand strong. Don’t ever underestimate yourself, your more than what you think you are.

    • I must agree with you… :) It does amaze me what people think and do sometimes.. Still waiting to hear back from the so called insurance company! I will stand strong and try not to underestimate myself.. I appreciate your nice comment.. thank you

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