Mom Died

It has been a long time since I posted. But I know that some of you still follow, so I wanted to let you know that Mom passed away on January 4. I was there. I am heartbroken and grieving.

Good News!

I got a job as a Visiting Assistant Professor in my field at a top liberal arts college not too far away. My new partner is going to make the move with me. Things are going VERY well! My surgery is on Wednesday, and I'm pretty scared about it. It won't be a fun process, but I am very grateful to have all of these good things in my life -- including a very good friend who will come into town just to take care of me! Thank god because I would never manage it on my own, and my biological family won't help me at all. I do miss my mom though very, very much.

When a Girl Needs Her Mom

So apparently I need surgery. I've been having pretty bad pain for the last couple of months, especially during my period. After a pelvic ultrasound, which is a little traumatic for a survivor, it appears that I have 2 cysts and 2 fibroids, each about 4cm. I also have endometriosis all over my pelvic area. I got referred to a gyn surgeon who wants to do laproscopic surgery who said that it will take between 2-5 hours depending upon what she finds. Recovery is a week or two, and for the 1st week, I'll need someone around to take care of me.

My sister said that she won't do it. I'm so hurt. I didn't ask my dad, but he didn't offer either. I had been talking about it with 2 friends and offered to pay their ticket, neither of whom are working right now, but I'm not sure if they'll do it. I'm feeling really freaked out right now. I feel vulnerable, alone, and I miss my mom. I need my mom to come take care of me, and she can't.

I've been going to this ridiculously expensive acupuncturist who apparently can cure cancer. He's got me on this disgusting "tea" and coming in twice a week, even though his office hours conflict with work. He told me that I need to lose some weight and that stress and trauma are having a big effect on things.

I want to confront my sister, but I don't know how to do it without being mean and starting a fight. I want to have someone in my life to take care of me. I have been seeing this really fabulous person, who has offered, but it is SO early in the relationship, it just doesn't seem appropriate. I don't want him to be my everything and to be so dependent on him. I want to have people in my life who I can lean on in times like this, and it sucks to think that maybe I just don't have that.

I'm having a hard time concentrating on work. I just want to cry and sleep and crawl up in bed snuggling with my dog. Yeah, I guess I'm depressed. I'm a little nervous that this could be ovarian cancer (which my grandmother died of) or that I'll be infertile (even though I prefer to adopt, don't know what this new guy wants, and afraid I'll lose him if I can't give him kids). I'm just scared, vulnerable, and trying to make it through.

On a side note, I'm really sick of the 90 spam attempts on my blog. Seriously, everything has to be approved, so stop trying to advertise on my blog.

Rape Victim's Choice: Risk AIDS or Health Insurance? Women Who Are Attacked Can Get Tangled in the Insurance System

By Danielle Ivory
Huffington Post Investigative Fund

1:38 pm | 21 Oct 2009

Christina Turner feared that she might have been sexually assaulted after two men slipped her a knockout drug. She thought she was taking proper precautions when her doctor prescribed a month’s worth of anti-AIDS medicine.

Only later did she learn that she had made herself all but uninsurable.

Turner had let the men buy her drinks at a bar in Fort Lauderdale. The next thing she knew, she said, she was lying on a roadside with cuts and bruises that indicated she had been raped. She never developed an HIV infection. But months later, when she lost her health insurance and sought new coverage, she ran into a problem.

Turner, 45, who used to be a health insurance underwriter herself, said the insurance companies examined her health records. Even after she explained the assault, the insurers would not sell her a policy because the HIV medication raised too many health questions. They told her they might reconsider in three or more years if she could prove that she was still AIDS-free.

Stories of how victims of sexual assault can get tangled in the health insurance system have been one result of the Huffington Post Investigative Fund’s citizen journalism project, which is calling on readers to provide information and anecdotes about the inner workings of the insurance industry. The project aims to uncover details and data that can inform the larger debate over how to fix the nation’s health care system. As the Investigative Fund reported in September, health insurance companies are not required to make public their records on how often claims are denied and for what reasons.

Some women have contacted the Investigative Fund to say they were deemed ineligible for health insurance because they had a pre-existing condition as a result of a rape, such as post traumatic stress disorder or a sexually transmitted disease. Other patients and therapists wrote in with allegations that insurers are routinely denying long-term mental health care to women who have been sexually assaulted.

Susan Pisano, spokeswoman for the health insurance industry’s largest trade group, America’s Health Insurance Plans, said insurers do not discriminate against victims of sexual assault and ordinarily would not even know if a patient had been raped.

"These issues you are bringing up, they deserve to be brought up,” said Pisano. "People who have experienced rape and sexual assault are victims and we want them to be in a system where everyone is covered."

Turner’s story about HIV drugs is not unusual, said Cindy Holtzman, an insurance agent and expert in medical billing at Medical Refund Service, Inc. of Marietta, Ga. Insurers generally categorize HIV-positive people as having a pre-existing condition and deny them coverage. Holtzman said that health insurance companies also consistently decline coverage for anyone who has taken anti-HIV drugs, even if they test negative for the virus. “It’s basically an automatic no,” she said.

Pisano, of the insurance trade group, said: “If you put down on a form that you are or were taking anti-HIV drugs at any time, they [the insurance companies] are going to understand that you are or were in treatment for HIV, period. That could be a factor in determining whether you get coverage."

Some doctors and nurses said that the industry’s policy is not medically sound. “The chance of a rape victim actually contracting AIDS is very low. It doesn’t make any sense to use that as a calculus for determining who get health insurance,” said Dr. Alex Schafir, faculty instructor at Providence St. Vincent Hospital in Portland, Ore.

Nurses who deal with sexual assault cases say the industry’s policy creates a significant problem for those treating women who have been assaulted. “It’s difficult enough to make sure that rape victims take the drugs,” said Diana Faugno, a forensic nurse in California and board director of End Violence Against Women International. “What are we supposed to tell women now? Well, I guess you have a choice – you can risk your health insurance or you can risk AIDS. Go ahead and choose.”

Turner, now a life and casualty insurance agent, said she went without health coverage for three years after the attack. She second-guesses her decision to take the HIV drugs. “I’m going to be penalized my whole life because of this,” she said.

Several women told the Investigative Fund that after being sexually assaulted they had been denied care or ruled ineligible for health insurance because of what were deemed pre-existing conditions stemming from their assaults -- particularly post traumatic stress disorder, or PTSD.

A 38-year-old woman in Ithaca, N.Y., said she was raped last year and then penalized by insurers because in giving her medical history she mentioned an assault she suffered in college 17 years earlier. The woman, Kimberly Fallon, told a nurse about the previous attack and months later, her doctor’s office sent her a bill for treatment. She said she was informed by a nurse and, later, the hospital’s billing department that her health insurance company, Blue Cross Blue Shield, not only had declined payment for the rape exam, but also would not pay for therapy or medication for trauma because she “had been raped before.”

Fallon says she now has trouble getting coverage for gynecological exams. To avoid the hassle of fighting with her insurance company, she goes to Planned Parenthood instead and pays out of pocket.

A New Mexico woman told the Investigative Fund she was denied coverage at several health insurance companies because she had suffered from PTSD after being attacked and raped in 2003. She did not want to disclose her name because she feared that she would lose her group health insurance if she went on the record as a rape victim. “I remember just feeling infuriated,” she said.

“I think it’s important to point out that health plans are not denying coverage based on the fact that someone was raped,” said Pisano of the insurance trade group. “But PTSD could be a factor in denied coverage.”

“That might not be a discriminatory action, but it certainly would seem to have a discriminatory impact,” said Sandra Park, staff attorney at the Women’s Rights Project at the American Civil Liberties Union. “Insurance discrimination against rape victims will only further discourage them from coming forward to law enforcement and seeking medical help.”

Even when patients have coverage, there are fundamental disagreements between insurance companies and doctors about what mental health treatment is medically necessary. The Investigative Fund spoke with doctors, psychologists, and licensed clinical social workers around the country who work regularly with victims of sexual assault. They said that their patients have been experiencing an increase in delays and denials, particularly for talk therapy.

“There’s a lot of anger about this in the medical community,” said Dr. George Shapiro-Weiss, a psychiatrist in Middletown, Conn. “You don’t realize what an Alice in Wonderland web this has become.”

“A lot of my patients are being told that their treatment isn’t medically necessary,” said Keri Nola, an Orlando, Fla., psychologist, who said about 75 percent of her patients are victims of sexual violence.

Several therapists cited problems with managed care companies that specialize in mental health. Such firms generally work under contract with health insurers to hold down costs while still authorizing appropriate care.

To watch a video about a rape victim’s efforts to obtain mental health services, click below.

Some therapists and patients said the managed care companies have cut off necessary treatment for sexual assault victims in the name of cost containment. “The companies are peppering them with questions about their symptoms, and about their histories, and asking, ‘Well, are you sure you really need therapy?’” said Jeffrey Axelbank, a New Jersey psychologist. “For someone who has been traumatized, it can feel like another trauma, and it makes the therapy less effective.”

Pisano, of the insurance association, said it was not fair to draw a larger pattern from such anecdotal evidence. “These situations are evaluated on a person-by-person basis,” she said. “There is nothing routine about this.”

Jim Wrich, a Madison, Wis., a consultant who helps employers evaluate the companies that manage their mental health care, said his work has made him wary of the industry. “This is absolutely routine – these denials,” Wrich said. “The default position is to reject care.”

Magellan Behavioral Health Services, Inc., one of the nation’s largest managed-care companies with more than 58 million customers, said that it does not routinely turn down treatment requests from victims of sexual assault or other clients. “We’re not denying care. We are exercising our responsibility to make sure that medical necessity is met,” said Dr. Lawrence Nardozzi, Magellan’s medical director. “I think the process works well.”

Asked if cost is a factor in the company’s decisions, Magellan spokeswoman Erin Somers said: “If all the safeguards are in place to determine whether treatment is medically necessary and appropriate” then “the cost takes care of itself.”

A former care manager for Magellan said in an interview that she felt pressure to deny care for cost reasons. Lois Gorwitz, a psychologist with thirty years of experience who went to work for Magellan in California in 2000, said her superiors would tell her: “We are not denying this person treatment, we are denying them their benefit. If they want the treatment they can still pay out of pocket.” But, Gorwitz said, “You know that means that the person is not going to get the treatment because they can’t afford to pay out of pocket.”

Gorwitz quit after two years. “It’s a very uncomfortable feeling of not being able to offer help,” she said.

Asked for a response, Magellan’s Somers said, “I think you should keep in mind that there have been a lot of changes at Magellan in the last seven years. I think the people who work at Magellan now are not having that experience.”

Link

Moving is a Nightmare

I'm in the middle of a nightmare. I drove across the country with a good friend who is a very good sport. It cost more than I expected to ship stuff, I didn't finish packing in time, and I stuffed the car to the brim and there was more left over. The second day, my dog got altitude sickness and then had a panic attack in the hotel room. Two days later, I saw my mom and family in Kansas City. Then next day, I saw a good friend in Indianapolis.

The whole trip took a week. I was exhausted when we got here, and so was my friend. I only had the rental car for a couple of days, so I tried to make the most of it. But, the short version is that I've been living without furniture, living out of boxes. The place here isn't safe and my dog is showing signs of extreme stress. Now, I'm showing signs of stress, :P.

I am trying to get out of my lease here and move into a new place, and the whole thing is a mess. Landlord WAS understanding, and then sent me a late night freak out email. The new place was a done deal, and now they may not take the dog. I'm completely and totally exhausted and about at my wits end. I feel very alone right now and scared.

Looking for a Place to Live

I'm looking for a place to live this weekend in Boston, and my stress level is WAAY up there. It is a bit of a roller coaster, honestly. I see a place, fall in love, and then someone else talks me through all of the problems with the place. I think that I found the place I want to live -- it is in the Jamaica Plain neighborhood, which is very diverse, relatively affordable, super easy to get to work, where many of my local friends live, feels like an urban neighborhood. I really like it here.

The place I found is 2 bedrooms - although the second bedroom is ridiculously small. There is plenty of space though to turn it into an office or a spare bedroom. I would have my own pretty nice washer and drier - although its in the basement. There's an off street parking spot. Everything is recently renovated and really nice -- that's pretty rare in the neighborhood. Oh, and it has a security system that I could choose whether or not to pay for -- but that would help with safety issues. There are places to go out and eat or have a drink and a gym around the corner.

But because of that, the price for the apartment is pretty high. Prices in this town are high altogether -- no matter where or for what. So I've been looking at possibly having a roommate too. But I prefer not to have one. I prefer to live on my own.

But I'm starting to freak out about paying so much money. I hate making these kinds of decisions on my own.

Its been a stressful week and time is just flying by. Its already 8pm, and I'm exhausted. I'm tempted to go back to that neighborhood and check it out more, but part of me wants to just take the place I like, stop worrying about it, and move on.

I feel like this decision raises a common issue for me -- which is spending money on myself. My father has trained me to spend as little on my self as possible. I've even been tempted today to call him and try to like get his permission to spend so much money. I'm a grown woman though and I don't need my father's permission. I need to give myself permission!

Ch-ch-ch-changes

It has been a long time since I've blogged, and I really appreciate those of you who continue to check back with me despite my hiatus from writing. I've been really exhausted. But, good things have been happening. I successfully defended my dissertation and graduated with my PhD. I've just received a job offer as a postdoc at a university on the East Coast.

I'm about to start teaching a summer course and figuring out the details of moving across the country. I'm feeling happy, but overwhelmed. I'm nervous about all that I have to do, not being able to take a vacation, not being able to make it to Israel for my friend's wedding, and starting my life in a new place.

I look ahead into the future, and I see things opening up for me. Everything I've been working for is right there.

But, things are horrible with Dad. And I have no idea about Mom's condition other than Dad continues to try to euthanize her with Oxycontin and Oxyfast.

There is a lot for me to do, but things are going really well. And I'm surrounded by really amazing friends. I'm a lucky girl.