Mental Health Care and Health Care Insurance

Mental Health Care and Health Care Insurance

Surely, it is no surprise that millions of Americans today are perfectly fed-up with the health care insurance industry, and the reasons are simple. The insurance industry is profit-driven ~ period. This means that insurance billing and claims systems are carefully designed and managed to do two things very well to best ensure high profits; (1) collect hefty premiums. (2) avoid or delay paying claims. Insurance companies don’t care the slightest about your health and wellbeing, they care only about their own bottom line. This may sound cold and heartless, but the truth is that the business of insurance is all about sustained profitability. This is precisely why the insurance industry is not user-friendly or user-attractive. In fact, insurance companies are hoping that you will become confused, frustrated, and overwhelmed in navigating your way through the maze of these complex systems that are set-up to capture revenue, and then pay little or none of it back out in the form of benefits and coverage. They want you to give up at claiming what is right and fair and just accept the system as it is.

Here are some very important points concerning mental health care and health care insurance services.

1. Health care insurance may be good for providing coverage and benefits for your physical health, but the same cannot always be said for your mental health. Many insurances don’t cover mental health therapy, or they will have a high deductible, or require a high co-pay for mental health treatment. Furthermore, the insurance product may only cover a few visits, and have significant limitations concerning what kinds of mental health concerns and conditions they will cover. Most insurance products are very narrow concerning mental health.

2. Mental health care providers who are billing insurance for treatment(s) are “required” by the insurance carrier to designate a mental health diagnosis (a medically-coded mental health disorder) to the patient’s clinical record. Truly, this information can then be used against the patient in the form of future denied claims or limitations and restrictions in accessing benefits and certain types of health care that they would allow or pay for. This system builds insurance profit.

3. The mental health diagnosis or disorder thus applied to treatment might not be completely accurate or fully relevant to the patient’s actual presenting needs or problems. Many practitioners feel as though they are forced into stretching and modifying assessments and evaluations so that the clinical diagnosis will fit-into the insurance carrier’s specific system of approved and qualified claims and coverage for services.

4. These “stretched” or otherwise “interpretive” diagnostics can cause patients to feel stigmatized, and categorized by a given diagnostic label. A patient may begin to believe that his or her life is more disordered than it really is, and begin to think that without critical treatment, things could remain problematic or get worse. This can create an inflated dependency on treatment and insurance use.

5. The patient’s diagnosis, no matter how accurate or inaccurate, then becomes a part of their unretractable medical record. This can have disadvantageous consequences. For example; certain disorders can completely disqualify individuals from accessing opportunities into various kinds of vocations and employment, such as the U.S. military and certain kinds of public service. These diagnoses and conditions will become a part of the patient’s medical record, and insurance carriers can then later find there to be “pre-existing conditions”. This is a built-in metric to raise premiums, deny coverage, or limit benefits and claims.

6. Of great importance is confidentiality! Since insurance companies always look for ways to deny claims and limit or otherwise control benefits, they will surely find ways to do it. And since they are paying for at least some of the patient’s treatment, they can access patient records. Here they will scrutinize treatment methods and objectives, question improvements made or not made (all very subjective), and challenge recovery or overall progress. They may ask the practitioner to prove that the prescribed treatment is “medically necessary”. And know this: An average insurance claim may pass-through more than a dozen different people who are trained to “evaluate and challenge” the merit of, or the necessity of the given treatment. This evaluation of the patient’s treatment is equally subjective and is purposely set-up to reject billing reimbursements to the health care providers and coverage for the insurance users.

7. Insurance fine print and hidden provisos within insurance policies are common in insurance plans. Remember, the goal of insurance companies is to collect money, but then not pay much or any of it back out. The “fine print” will contain listed exceptions and disqualifying language which can be difficult to understand.

Taking control or your mental health care and protecting your money, your very personal and confidential mental health information, and your dignity may best be accomplished by accessing mental health counseling services independent of an insurance carrier. Consider carefully the costs, risks, benefits, and alternatives before deciding how you are going to pay for your mental health care. Ask your mental health provider to explain the pro’s and cons of using insurance and the same in paying “out-of-pocket” for clinical services. Advocate for your own best interests and needs.

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Counseling Federal Employees

Counseling Federal Employees

Years ago, there was a man on the committee which hired me in San Antonio. He had worked for the federal government since he returned home from military service in World War II. He was my Dad’s age, he had no kids, and my folks lived in Kansas City, so we became family of choice.

You’d have loved his warm smile and bright eyes flowing from his unselfish personality. You’d have respected how he climbed the ladder of GS ratings through devoted hard work. And, you’d have been heart broken when his kidneys failed.

We hear a lot of bad press about bureaucrats and federal employees pursuing and exercising power for selfish reasons. We need to hear more about people like my adoptive father. When he had to retire after 30 years of service, he had accrued a couple of years of vacation and sick time he had not used over his career. After he stopped working, he continued to receive the salary and benefits he had earned over the decades and made life a little easier on his wife during the treatment years.

I miss him.

I want to continue to work with and for people like him. His vocation was a federal employee, but his passion was this country. He served the nation to continue what was good and to solve bad problems. I want to serve such public servants. Your Blue Cross will pay for your services here.

If you need a counselor who is a preferred and experienced provider with your FEP insurance, no matter where you live (we can use Telehealth).

As Paul Harvey used to say, I’ll tell you the rest of the story: 509-466-6632.

Changing the Conversation

We all know the power of words; we have seen it throughout history. If you hear the words “I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character” you instantly know that this is from Reverend Dr. Martin Luther King Jr and his I Have a Dream speech in Washington D.C. Or maybe the words “Ask not what your country can do for you; ask what you can do for your country” from a speech made by President John F. Kennedy. These words are often quoted as beacons of hope and mission; they are respected oratory from major figures in American history.

I work in words. I don’t have the ability to intervene in someone’s health with medicine; yet by using the training I’ve had, I can use words to help people see their own potential. It can be an important part of restoring someone to a healthy life, and it can be powerful if done well. Yet we all have the power to use words to make positive change in our world, and destroy it.

Recently in the Spokane Washington area, where I live and work, we had a school shooting. Four students were shot, and one of them was killed. This has been a devastating event to every member of the immediate community where this took place, and the Spokane region in general. As I have begun to see my clients since the incident, I have been checking in with them to see how they are dealing with it. Most of them were shaken initially, but are doing okay now. However, one of the continual things that I have been hearing is the way some young people are making flippant comments regarding suicide and school shootings in their daily lives; I have often heard adolescents tell me that it can be difficult to know who is serious and to get adults in their schools to take them seriously. Even if the school has a zero tolerance to this language, kids are afraid that their peers will figure out who brought it to the attention of the staff in their schools.

While I have been working in private practice for a while now, I still get taken aback when an adolescent gets to my office and describes to me that their peers say things like “I’m gonna shoot this place up” or “Why don’t you just go kill yourself” regularly when they are at school. In most cases kids do not act on these suggestions, but there are young people who are emotionally vulnerable; these words can affect them greatly. Almost no child would ever mean either of those statements as a serious undertaking; yet imagine the feelings of guilt that they would experience should a vulnerable child act upon those words-and what might be the horrible consequences legally.
Yet is there a way for us to put a stop to this behavior? I look to my own experiences as a child and as a parent for those answers. When I was a child, I grew up in the Midwest; the area where I grew up was about as southern as you could be without being in the South. During my childhood in the 70’s and 80’s there was a word that was often used by my peers—that being the “n-word.” On one occasion I was talking to my mother and used that word in conversation; she immediately made it clear that she would not tolerate that word in her home, and that should I ever use that again, there would be prompt washing my mouth out with soap. That word immediately was removed from my vocabulary.

In my own home I do not tolerate using the word “hate” toward a member of the family. If either of my children used it toward each other or me, there was an immediate response of disapproval and dislike. My goal was to help my children understand that this was not an appropriate way to express anger and frustration, and that it can be extremely hurtful and venomous.

There is a way for us to make these sayings inappropriate for adolescents to use toward one another; we must set a standard within our families as to what is acceptable and what is not. It is just as important to teach children from an early age that not only should they use gentle touches toward each other, but gentle words as well. Sometimes the words can be more painful than the physical aggression if left unchecked.

It has never been easy to raise a child, and adjusting to having a teenager can be the most challenging stage of the parenthood journey. Yet it is important to remember that just because our kids have the word “teen” in describing their age does not mean that they don’t need us to help guide them through the last critical years of childhood into the responsibilities of adulthood. Teaching our children how to respect and care for each other, those they love, and those they will meet in their future is one of the most important responsibilities we can have as parents; it is paramount that we make both word and deed a part of that education.

How to be the Meanest Mommy in the World!

Holly T. Meginniss, MSW, LSWAIC

I spend a lot of time working with families, particularly with teens and their families, on the need for teens to experience the natural consequences of their choices, good and bad, as well as taking responsibility for mistakes. I work hard to assure my families that I do empathize with them how difficult it is to see your child struggle. As I say, it is easy for me to say, but not always easily done.

But the truth is I have been exceptionally lucky to have two children who have been able to learn lessons with a minimum of traumatic consequences; my daughter is now an adult who works in a job of considerable responsibility, and recently married a wonderful young man whom she has dated for several years. My son is about to start his final year of high school, and is exceptionally bright. He has also learned a strong work ethic, and with the challenge of ADHD has understood the importance of taking his medication daily, and developed habits to manage his symptoms that allow him to be successful at all his endeavors.

Recently my son was given the opportunity to do some photography work at an event for kids; to be able to tell the story well, my son was part of the staff that stayed with the campers for the entire event. Near the end of the event my son realized that during the travelling around to different activities in the area he had lost an integral piece of equipment needed to complete one of the assignments, as it needed to be done for the final day of the camp. He contacted his sister, who was not sure how to handle the situation, and sought advice from me. Of course, this all happened late in the evening, and it was going to be about 2 hours of running around for myself and my daughter.

I became frustrated with my son, and expressed this on the phone. One of the dirty little secrets of my profession is that sometimes emotions get the better of us and we make mistakes with our own children. This did not help the situation, as my son was plenty hard on himself. As my daughter and I were harping and getting ready to make the trip, an unexpected voice of reason came forward—my son-in-law. He gently reminded us that he too struggles with ADHD, and has made mistakes in his job that he has had to solve; if it were him, his wife would have had him solve the problem.

I realized that he was right; as excruciating as it was, I called my son back and told him we were not coming. I gave him suggestions on how to calm down, and we formulated a strategy to let the other staff members know what was happening, and see if they could help him brainstorm ideas how to solve the problem. I also assured him that if worse came to worse, his brother-in-law would be there early in the morning as planned and would bring another computer. I went to bed knowing I did the right thing, but feeling like the meanest Mommy in the entire world.

When parenting children, it can be so hard to be the voice of reason, and to not save them from their mistakes. Yet if we want to be their first and best teachers, we have no choice. I often refer to this as “controlled failure”; when children have opportunities to struggle and problem solve when the consequences are not catastrophic to strengthen those “muscles”, they are able to take the reins when the problems arise on their own with confidence. It also gives children the opportunity to feel the success of problem solving, and the positive consequences of taking responsibility for making mistakes. In that we help our kids gain the most valuable gift of all, wisdom.

My son did practice problem solving, and not only did his project get rave reviews, he also got the piece of equipment back. He came home from the trip tired but satisfied with his work. He also said that he learned his lesson, and will make sure he can’t get stuck again in this situation.
Mission accomplished.

Co-Worker Stress Relief

I am working with three clients right now who entered counseling due to a toxic relationship with a coworker. I have been reminded of a time when my father had to deal with a toxic supervisor. Dad had spent his career on the railroad, retired, then was given an opportunity to help a neighbor by working as a security guard. While on the railroad, Dad had been involved with many coworkers who struggled with addictions and interpersonal relations problems. Even there, he had not worked for anyone as toxic as his new supervisor.

He called me one day and discussed all that he had tried and how frustrated he was dealing with this man every day. He said, “You’re a counselor, so what should I do, quit?”

My father had read through the Bible more times than anyone I’ve ever known, including my professors in seminary, who were very familiar with the Bible.

So, I asked, “Dad, what does the Good Book say about dealing with your enemies?”

He mumbled his reply, “pray for them.”

“What did you say?” I confronted.

“Pray for them,” he replied a little louder.

“Let’s just do that,” I suggested. He agreed. I started praying every morning for his boss.

A couple of weeks later, we were talking again, and I brought the subject up, “have you been praying for your supervisor?”

“Yes, twice each day,” Dad answered.

“Has anything changed?” I asked him.

“Well, yes it has,” he admitted. Dad described some of the changes he had noticed over the last two weeks that were big improvements in the attitudes and behaviors of his supervisor.

“That’s great!” I congratulated.

“It’s not just that,” Dad continued. “I’m not sure that all of the changes were from my boss.” Dad elaborated that praying twice a day for his supervisor may have also changed my Dad. My father thought our Heavenly Father must have also changed Dad’s perceptions of the man he was praying for.

Perhaps that is what Reinhold Niebuhr had in mind with his serenity prayer, “God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and wisdom to know the difference.”

It’s difficult enough to change ourselves, much less others. My father accepted that his co-worker had things that needed to change. I am glad that he had the courage to recruit help and that he took Biblical advice.

If you are going to work every day and spending more waking hours with coworkers than with your family, then recruit help like my father was humble enough to do. You might try what my father tried and pray for the most toxic employee. Observe what changes in your coworker and in you. You will at least be proud of yourself for doing something courageously and you’ll become more compassionate through your prayers. If you need more help, then call us at (509) 466-6632.

Back to School: Books, Backpacks…and Bullies?

Back to School: Books, Backpacks…and Bullies?

Back to School: Books, Backpacks…and Bullies?

Holly T. Meginniss, MSW, LSWAIC

A few years ago, there was this great commercial by a national office supply chain that I loved. It was a Dad dancing down the aisles to the strains of “It’s the Most Wonderful Time of the Year” a traditional Christmas tune. As Dad is gleefully tossing pens, pencils, notebooks and all the things needed to start school, the camera pans away to two school-aged children who are decidedly not amused. Their furrowed brows and grumpy faces say all that needs to be said about how they feel about the “Time of the Year.”

While we may lament and secretly be happy that our children are returning back to school soon, there are other things that are important to do in order to deal with some of the difficulties that can come with returning to schools, particularly dealing with bullies. Bullying is something that can overwhelm a child quickly once it begins; embarrassment and/or fear can keep them from reaching out to adults or school staff in order to deal with the situation. Sometimes adults have a difficult time seeing the difficulties through the child’s perspective; the adult experience and wisdom brings about the tendency for us to say “this too shall pass,” or “it’s no big deal.” Stories have already begun to appear on news outlets and social media of children who have taken their lives in an impulsive action to relieve their immediate pain, only to bring about permanent and devastating results.

Bullying has become a much less tolerable behavior in most school districts. But as the parent, how do you advocate for your child to be certain that a culture of bullying is not being tolerated at your child’s school? Many parents don’t know that there are things you can do, both to prepare your child to know what to do if they are bullied, and what rights your child has in the school if they become the target of a bully.

  • Teach your child that they need to speak up, and that you will listen:  Many children are initially afraid of telling their parents about being bullied at school, often because they are not sure how their parents will react. Let your child know what you want them to do if someone attempts to bully them, including on social media. Having a specific plan on how it will be handled so they are able to know that help is going to be there for them.
  • Make yourself aware of the school’s and the school district’s policy on bullying: In Washington State, there is a law that specifically addresses Harassment, Intimidation, and Bullying (HIB) in public schools. There are specific processes that are required to take place when a bullying complaint has been made at a school, and each district in Washington State is required to have a compliance officer who is responsible for assuring that the schools in a district are meeting their requirements. This is handled in Washington State by the Office of the Superintendent of Public Instruction (OSPI). It is important that as parents, you are familiar with the bullying procedures in your district, and how you can contact the compliance officer if you are not getting the support your child needs. Here is a link to the OSPI website page on the HIB law; this includes information for parents and loved ones of children who are bullied http://www.k12.wa.us/SafetyCenter/BullyingHarassment/default.aspx
  • Know who your child is hanging out with, in person and online. As children are getting older, more and more of their social life is conducted on social media. It is important that as parents you know what is happening. I always recommend that parents have the passwords to all accounts that a child has. When dealing with bullying in teens, it is often not relegated to the school, but also happening on social media where disparaging words and deeds are seen by the cyber universe.
  • Get involved in school. In today’s world of technology, it’s important for parents to take advantage of opportunities to know what is going on at school. Many districts who have digitized grade keeping systems make access available to parents as well. Become familiar with how the program in your district works, and check grades frequently. Sometimes suddenly slipping grades are a strong indication that something is going on in the child’s life that is keeping them from succeeding at school.

Children who bully are also in pain; they are at an extreme where their anger and frustration is being expressed in unhealthy and unacceptable ways. There is no excuse for bullying anyone; children who express bullying behavior can often be helped with counseling to resolve their emotional issues. Additionally, children who are being bullied may feel so overwhelmed that they see no way to feel better without hurting themselves by self-injury, or in the ultimate act of pain relief, suicide.

There is help. I am a Mental Health Professional with a Master’s Degree in Social work who specializes in child, adolescent, and family therapy. If you are looking for someone to work with your child and/or family, I have openings that are convenient for children and families. We accept most major insurance plans, including Medicaid. Please give Healthy Counseling Center at 509-466-6632 to schedule an appointment.