"They told us she wasn't sick enough"

Marcy is speaking on behalf of her daughter's struggles with the healthcare system. They have insurance with Kaiser that is paid through by her husband's work with the school district. Marcy's daughter has struggled with a variety of mental illnesses throughout her life. In particular Marcy wanted to focus on her struggles getting treatment for her daughter's eating disorder. She was sent to residential treatment three times through the local residential program that partnered with Kaiser. Marcy's daughter's problem lay with this residential program; it didn't give her enough support in the areas that she needed. After her third relapse, Marcy began looking for a different residential program for her daughter to go to.

I talked with Marcy about her struggles with Kaiser and the pushback she received after advocating for an out of organization treatment. Marcy found that while getting into the Kaiser partnered residential program was fairly easy if the doctors deemed it medically necessary but that getting into a different residential program was nearly impossible. With Kaiser, if you want treatment outside of the organization, you have to file a request that takes around 30 days to process. If you can prove you are in dire medical need, there is a grievance period of 72 hours that the insurance company will get back to you; those seeking basic mental health support must wait the full 30 days. The insurance company additionally requires a detailed reasoning for an out of organization treatment. When talking with Marcy, she said that when advocating for her daughter's treatment she not only had to explain why her daughter needed new residential treatment but also had to research the differences between the two programs and report that back to Kaiser. In this process, Marcy wasn't the only one who had to advocate for her daughter's treatment. Marcy's daughter and the entire family had to have numerous meetings with doctors and insurance companies to explain why they felt they needed this new treatment. This process was extremely draining and time consuming, and in the end, Kaiser granted them access to the program they were seeking.

When talking with Marcy, I noticed that in their process, there seemed to be a lot of waiting on Kaiser that prevented her daughter from getting the treatment she needed. I was interested in understanding if Marcy felt her daughter's challenges with healthcare affected her recovery. I wasn't surprised when Marcy said that "yes, I feel like if my daughter received a more complete treatment that addressed the various aspects of her mental illness, it would've been a very different outcome." Because Marcy wasn't able to get immediate care for her daughter, the bulk of her daughter's mental health treatment fell into her hands. Marcy recalls looking after her daughter being as exhausting as a full time job: "it is hard to care for my out needs when it feels like she is in an emergency 24 hours a day 7 days a week. When the medical system didn't address her needs in the way I saw them that was really hard. It wasn't until she was hospitalized that there was intervention and she was offered support. I think that is terrible for the patient because she could've lost her life, and it's terrible for the healthcare insurance because they are spending hundreds of millions of dollars on intervention when they could've spent a few thousands of dollars on preventative care and therapy."