Friday, June 15, 2012

Naming names

I have often worried that by using my children's names I may be sharing too much about them for their own good. I do not so much worry about what folks think of me. I believe that the problems facing our family are nearly universal, and yet many folks would prefer not to share such information in order to protect their children from any invasion to their privacy.

I no longer care whether my children might be candidates for Ivy League degrees. I do dare to hope that readers will view these notes with understanding toward the young people whose vulnerability may be exposed here.

That said, I feel less protective of the adult representatives of civic and social service agencies whose interference in our affairs has yielded no improvement in the welfare of my children, much less justice for the wrongs done to them. I feel no protective instincts toward the Guilford police, for example, who failed to develop an adequate case against the man who sexually assaulted two of my daughters. Nor the Guilford School District, which harbored not one but two running coaches known to have had illicit relationships with young girls. Nor yet the lawyer who defended our rapist in court--the same vicious, lying clown who represented Joshua Komisarjevsky. Nor yet toward the social workers at the Connecticut Department of Children and Families, who investigated a claim against me personally that was filed by the wife of my daughter's rapist, alleging that I am an alcoholic who beat my children. Nor yet toward Anthem Blue Cross and Blue Shield, which has paid but a pitiful share of the costs of mental health care for three children suffering acute (suicidal) symptoms of post-traumatic stress, and which further insists in writing that my son, Tim, is at fault for his own continuing suicidality and addiction.

This latter claim comes in response to an appeal filed against Anthem's decision that Tim's residential treatment is unnecessary to his care. They insist--despite ample documentation from Tim's doctors and other clinicians--that Tim's only problem is marijuana use, and that if he would only obey parental injunctions to abstain, he would be fine living at home. Never mind the evidence of PTSD; never mind that when he gets high on marijuana he suddenly feels compelled to take life-threatening doses of morphine or ecstacy. He just needs to behave better, and all will be okay.

While Anthem forestalls any reimbursement, I am paying for Tim's ongoing care by emptying my retirement account. I have reported our conundrum to the Hospital of Saint Raphael, my wife's employer and the source of our health insurance. The very polite women in the Human Resources office there explain that, overall, they consider Anthem to provide very good coverage. When pressed about Anthem's record on mental health--which includes repeatedly denying receipt of claims and the provider paperwork required to process them--they admit that "the only real problem is how Anthem handles mental health." I point out that "the only real problem" is ruining us financially. They promise to demand answers, which yields long conversations with Anthem's appeals team, who promise to expedite all the paperwork if only I can get all the providers to resubmit it. The real problem, they explain, is that we are using out-of-network providers--no wonder we are getting snagged in their paperwork! They still deny that Tim requires residential care.

Fortunately for us, Connecticut sponsors an Office of the Healthcare Advocate, whose legal team is pursuing a complaint against Anthem for their evident attempts to evade reimbursing essential care. And yet even they have to warn me that Anthem is grandfathered out of the Connecticut law that mandates fair treatment in such cases. So, we could lose.

My wife's employer, the Hospital of Saint Raphael, is famous for rescuing the destitute from the streets of New Haven--no insurance required. Ironic that they can't do better by their own "insured" employees. Saint Raphael's is currently being swallowed by Yale-New Haven Hospital--a financial necessity in these times, I am told. The other day, my wife attended a presentation about her new healthcare benefits and came away optimistic about the new, more comprehensive Anthem plan that will take effect in a little over a month.

I'll believe it when I see it.

1 comment:

  1. I'm so sorry for your troubles. You and your family are in my prayers. Your level of candor on the blog is startling -- I suggest you should be guided by your family as to whether you are sharing too much. It can be therapeutic to acknowledge the elephant in the room. Your love for your children shines through the anger and the pain, and I have no doubt they see that, too.