Anyone with medical backround or insurance knowledge HELP!

I have been asked to reach out on behalf of my family. I'm going to change names around here for anonymity.

One of my family members, Alison, has been diagnosed with Bulimia. She is reallllly bad. She has been doing this for about 4 or 5 years secretively and has finally dropped so low in body weight that her parents have noticed. She is 5'6 and 100lbs, dropping fast. She can't hold anything down at all. She is still living at home and is 25 years old with a job and health insurance. Her parents took her to the doctors this month and set up a really great treatment plan for her.

Unfortunately, it is VERY expensive even though she has insurance. It is outpatient but 5X a week and the copay for each day is $75!!! Plus she has to see another doctor once a week at $25. Her family absolutely cannot afford this, but she absolutely cannot afford to skip out on treatment. She is too sick and needs this.

What can Alison or her family do to afford the treatments? Does anyone know of state/federal help that she can apply for even though she already has insurance? They spoke to the center to see if they would help with the copay costs but they said she would have to sign up and pay the costs for a while before they would start billing her and working out a payment plan and the money is just not there to lay out for these astronomical copays.

Any suggestions guys? This is getting REALLY bad very fast and we are all very worried about her. She is starting to loose her hair now and is severely malnourished. We don't have much time left.

We all live in NY on Long Island if that helps. If you need more specifics, feel free to PM me. Thanks.

Dear LG,

I don't have the background you requested.

Do you have a state medical program that she can sign up for?

May I suggest that you start searching online? You probably are doing that already anyway. I searched on "low cost bulimia treatment" and I got good assortment of listings.

I saw some good suggestions for crisis. If she's in crisis, don't wait, call 911 or take her to the emergency room. This is a life threatening matter and she needs help now. I understand about the money, but when it's that critical, it's important to take action quickly. I know money is really an issue, but saving her life is the most important issue of all.

I have very little money so I do understand. However, when I've had medical emergencies, one of which was a ruptured appendix, I went to the hospital.

I wish you and your relatives the best!

Chris

I would add that maybe the ER can admit her so that they can get some IV fluids and nutrients into her that way while the family figures out what to do?

I'm sorry, LG. I feel for your family. You're all in my thoughts.

Unfortunately Alison doesn't want to go this way and she is..hate to put it this way...spoiled. She will get what she wants until she passes out from malnutrition and if her doctor doesn't say "She needs to go to the hospital for fluids," Her parents won't take her. Her doctor won't tell them that because Alison is lying to the doctor and telling him that she is holding down a lot more than she is. I wish this were simpler...

LG - I know many families that have fought with this. The person with the disorder will refuse to go to the doctor or ER. At that point you get no choice - they were made to go. I know this is family and it's all the weird dynamics but it's her life at stake. Allison obviously doesn't get it and everyone can say it until they're blue in the face. I guess the only thing that can be done (and this would have to be your parents) is to say: Look honey, we love you but either you go to the ER for fluids or we are hospitalizing you. The hospitalization is the last thing they want and will usually submit to going for fluids.

On the insurance issue...there aren't a whole lot of options. From what I've observed, there is little that insurance will cover in this area. At least until all the permanent damage is done and then they are treating her for heart failure. Usually the patient has to pay for this...just what I've observed but perhaps find a group that is for eating disorders? Just thinking if they had a few that have been there and done it they may have some insight.

In California, there is something called a 5150 (Involuntary psychiatric hold) which allows a qualified police officer or clinician to involuntarily confine a person deemed to have a mental disorder that makes them a danger to him or her self, and/or others and/or gravely disabled. I don't know if you have the same process in NY, but I suspect you do.

Now whether or not a qualified officer or clinician could be convinced you cousin needs temporary confinement is another matter. If it were my relative or friend I would try to talk to the police. But then many of our local cops have had special additional training in dealing with folks in emotional/mental crisis and they do not approach these folks in the usual cop hard line way.

Other than involuntary confinement, if she, her parents, and her doctor won't seek help for or even admit to the bulimia, I don't see what can be done.

Perhaps you'll find a better answer from the knowledge here at Ronda's.

Am no expert but have a little experience in similar situations. One friend had anorexia which is similar. I believe you basically have to treat as if the person has an addiction. Twenty four hour watches.

My friend would eat healthy things, if forced, and after her initial crisis point had to present herself everyday at her gp to eat a mars bar while he watched. THis was some way down the track.

For the food intake, buying a calorie book, sitting down with her to agree on a diet that will give her sustainance, she may accpet a low cal protein drink if your lucky, carrots, celery sticks with low fat cottage cheese, let her decide what she finds acceptable and encourage her to stick to it. This mutual agreement places the emphasis equally and everyone is aware of the rules.

The bingeing has to be curtailed at all costs to prevent sly vomiting ergo the 24 hour watch.

The compulsion is caused by low self esteem and mirrors cannot convince the person they are underweight. With the low self esteem is the conviction they are unloved and unwanted. In a way a slow form of suicide.

This may or may not have been caused by something/someone in her life. It could be something so bizaar that it will take years to sort out. If you can't find a pysch. make sure her close friends visit, she may talk to them. And their presence may motivate her into coming back to her old self. Letting her shut off from her peers will only allow her to think that "Noone visits - noone loves me."

In Oz you can do similar to what CRT says. We signed a friend in with a drug problem. He was beyond helping himself and even as friends our authority was enough to have him admitted. So if the situation becomes even remotely close to desperate don't hesitate.

Thanks guys, I will discuss all of this with her parents. I believe they think she is holding down small bits of ensure but she is vomiting them up, I heard her do it but they wont believe me. She yells at them to give her privacy and THEY DO! This is really tough but I will tell them about the involuntary admission and especially about the 24 hour watch plan Marion mentioned. You post some good information on this, thanks for the insight.

Keep it coming if you guys have anything else...we need everything we can get to help her. This is so hard especially because everyone sees her as a sick little girl who should get whatever she wants. This isn't true, she needs to get HELP, not privacy and time to binge and purge.

She's a sick little girl alright but getting what she wants is killing her. Honestly, I wish you the best of luck in trying to get through to her parents.

Chris

Thanks Chris. I've been trying for 4 years and I haven't gotten very far so I don't know how far I'll get even now. I feel horrible being that I knew about it and said things but was ignored and didn't push it when I knew. I don't think anyone would have listened because Alison always gets what she wants in life and always has. She has been raised this way and now it is really turning against her..

There was an episode of MASH years ago that says it all. Pierce finds out a soldier is underage and sends him home. The kid leaves screaming I HATE YOU, and Alda's character replies that he hopes he hates him for a very long and healthy time.

If you think it has gone to far get social services involved. If she hates you and the family hate you, tough! Better that than have her death on your conscience.

If you think you have some time use this as a lever on her and her family if you have too. "I love you and I will not stand by and watch this happen." Your anger might be enough to shock her into behaving. The prefix of I love you empasises that there is someone there for her who will go to any lenghts for her and stand up to her family. The anger in your voice emphasises that here is a person willing to take charge of her life.

LG,

If her life is in overall jeopardy, the ER will do an eval and admit her if necessary, and most likely a psychiatric consult will be done. If she has health insurance, there should be behavioral health or mental health coverage--typically this is separate from health insurance. You can tell just by looking at the back of the card...

There should be a couple numbers. One for typical health related coverage, and another for mental health/substance abuse. The best thing is to find out what type of coverage is available. The health plan's "Summary Plan Document" spellls out what is and what is not covered. Remember, privacy laws apply, and most likely family will not have access to info, unless there is a crisis. Typically the hospital would trigger this through their evaluation and admissions if needed.

Outside of private insurance, this would be an out-of-pocket expense. There are a lot of details that go into this. First and foremost, her medical needs will be attended to.

Good luck.

Unfortunately the copays on her private medical insurance are too high for the care she needs. Nobody can afford it..it just isn't even realistic. It would be $400 a week!! I know she doesn't even make that much! Her parents would loose everything to keep her in treatment so they are looking for other options.

Hmm, tough situation.

Someone needs to make some calls to the insurance company, the treatment facility/hospital, and local social service agencies.

The family may have to outlay a certain amount to get things rolling. If a 6 week treatment program costs $2,400 (6x400), they might have to step up and find a way (negotiate costs with hospital). There may be maximums that apply where copay/deductibles cease.

It all depends how sick she is, and if she is a dependant/minor or over 18. Some programs have savings maximums that require you to spend down until you hit a floor. It's like when an elderly family member ends up at the end stage of life--going into a nursing home.

If granny has $50,000, and it costs 128/day for nursing care, you have to blow through almost the entire amount, save ~8900 before state/federal programs kick in.

Some phone calls finding exactly what benefits she has, and what can be worked out needs to be done.

Just remembered -was a long time ago friend had anorexia. Big clue to their physical health is whether still menstruating.
It is one of the first hints that the body is going into self preservation mode by shutting down the non-essentials.

Suggest a support group or forum like this one. Although professionals and family can try to help....like we know so well, only the voices of those who truely know what it's like to walk in the shoes can soothe.

Maybe research some forums and suggest them to her-telling her how much you get from this. I know it may not be immediately life saving.....but then again...it may be a good start? Feeling understood an "normal"/not alone is an important part of any treatment/recovery.

Good luck LG. It's sweet of you to reach out for support and info on her behalf.

Hi All,

The way i see it there are a couple of options.

1. Allison could stay in the outpatient program. I kn ow it is expensive, but if this is what is going to help mort or if this gives her a better chance- maybe she should stick with it. Most insurance companies have "case managers" who can look into treatments and guide them through what is covered by insurance for this disease. The other choice, if she decides to stay in the outpatient program would be to talk to the program administrators/billing office and see if anything can be worked out financially. (maybe a sliding scale-something.)

2) Have her primary care doctor admit her to the hospital for fluids, possible IV nutrition, and any other workups that need to be done. This may buy you and your family some time. This would allow for a full work up- including a psychiatric workup. It is possible that this would be covered by insurance and may give the family and opportunity to decide which treatment is best. I know that there are several hospital around the country that have inpatient treatment for eating disorders. (From what you have said, I think that some sort of inpatient treatment would be best.)

3) Have her admitted through the ER for fluids, malnutrition etc. If her parents hold power of attorney and it is clear that thier daughter is still bulemic, I think that it would be possible to put a psychiatric hold on her. The problem here is that once a certain period of time has elapsed, or the hold has expired, I am not sure she can be held much longer without having her declared "mentally incompetant" by a judge. From what you have said, she is a smart young lady who is dealing with a horrible disease, so it might be nearly impossible to go this route.

I would definitely talk to her parents and to your neice. I know that the outpatient program may be easiest for her, but if you are pretty sure she is still showing symptoms, I would think being admitted to the hospital for a work up by her own drs is the way to go. This way, she will be with some drs she already knows and they may be able to transition her to outpatient treatment. I would suggest that you talk to her parents and to your neice about the situation. If needed, you can give her a choice-go voluntarily or go through the ER.

I wish that I had more advice for you. I had a cousin who was severely anorexic and her parents had her admitted for inpatient treatment. In her case, it worked extremely well. It was quite scary for a while, but she gradually got better and now has a successful job and a wonderful fiancee.

I also had the unfortunate privelage of seeing what could happen to a bulemic/anorexic with little to no treatment. One of my roommates in college was anorexic and bulemic in high school. Her parents did not pick up on the fact until she was diagnosed with pnemonia and had to be hospitalized. The drs did give fluids and iv nutrition as well as antibiotics. I know her doctors strongly reccommended that she get some help for the problem on an outpatient basis. However, her parents did not believe in seeing a psychiatrist. She eventually overcame it by herself, but sometimes, we would have to make sure she ate. She is ok now, but it was hard to see and to hear about.

I hope that things go well and that your neirce is able to get some help ASAP.

Pain free days,
sailingm

I really feel for you.

It is fantastic that you are trying to do something for her though.

After reading all the posts, I can only think of one thing to add.

If there is a Catholic hospital near, they are non profit and have funds when you cannot afford to pay even if it is just out of pocket expenses.

Doesn't matter what you make either, that only affects how much they will write off.

We know lots of folks like us that have had part or all of their out of pocket expenses written off so it might be worth a try.

Good Luck.

Cindy

Wow thank you so much. Her mother is part of a Catholic church and I believe they can point her in the right direction in that matter. I will surely bring that to her attention right away. Cindy, thanks so much! This is one thing they may do. I know they had plans to visit a inpatient treatment center somewhere a bit closer to home (still a trip!) but it was still expensive and Alison would still have to quit her job and go on cobra which is costly. She doesn't have a lot of paid time off yet, she started not too long ago so the funds would fall on her parents. This would help a lot

Thanks for the input everyone, I really appreciate all your suggestions. I have noticed when I went over there recently that there was a half empty box of ensure bottles and a few empty cans in the garbage. I do not know if she has purged them...I don't live there. I can only hope they are controlling her but I know she goes to work, too. At least at home she can receive SOME nutrients until she gets enrolled into treatment and until then I don't feel the need to call emergency yet. I will definitely be keeping a close eye on her though and if I see a drastic change in her appearance I will definitely call right away!

I'll keep you all updated. Thanks again guys.

Hey lovegia,

Here in BC (Canada) anorexia and bulimia are not treated under the mental health act, meaning, the "state" will not force treatment on individuals and no judge (here) would ever find an individual mentally incapable under these grounds.

Both anorexia and bulimia are often treated in the same way as addictions, with interventions on the individual to point out that their behavior is no longer acceptable and that the family/ support system is no longer willing to stand by and watch him/her kill his/herself.

Some young people with anorexia will endure treatment long enough for all the family funds to run out and then resort right back to the same behaviors that brought them into treament. Your family needs to get together and discuss the "bottom line" and determine when enough is enough.

She needs to hear that her support system will no longer support her in her behaviors. Of course, this is all useless if some of her supports then back out of their bottomlines.

This is a very tough issue and almost always has families pushed to the limit with a lot of enabling and codependancy.

Gia, this is really sad. I am so sorry you have this happening to your cousin.

You are too young to remember this but Karen Carpenter (from the musical group, The Carpenters) passed away in the early 1980s from this. She succumbed finally to a heart attack. The purging causes great stress to the heart.

You might want mention this to your aunt and uncle. I am sure they remember Karen Carpenter. See if you can find something about her online.

It is such a shame that money has to be the first consideration with catastrophic health situations. I am amazed that your cousin can hold down a job considering her health.

Another thing you might want to consider is that your aunt and uncle are not legally required to pay for Alison's care. If she could be admitted to a facility where she could get help, perhaps Medicaid would help? She'd have to quit her job, of course, but that is of little concern when one is dealing with a life and death situation.

Please keep us posted on Alison's treatment. I hope she gets help and is able to live a normal life soon.

LG,

There are also funds under the Hill-Burton Act. See here:

http://www.hrsa.gov/hillburton/compliance-recovery.htm

I'll keep your cousin in my prayers. What a wonderful cousin you are, LG. Your cousin is blessed to have you in the family.

Take care,

Becky