How American insurance companies starve patients to death

“I can’t accept this; I don’t deserve to have this.  I just can’t do it.”

A year ago to the day, I realized I could no longer go outside safely. People whispered and stared like I was a freak show, mothers gulped shock and breathed sickened glares at my family, students at the university reviled me. I vividly remember one group of athletic 20-something’s guffawing that I was “hungry skeleton mode. What the f**k, dude!”

To be fair, I was a sight at a BMI of 12, but the reasoning behind my appearance could be traced back to a confluence of events that instigated a genetic disposition completely out of my control.  I was suffering from Anorexia Nervosa, a disease that cohorts with other illnesses including depression and anxiety to generate a calamitous disorder that exceeds the mortality rate of any other mental illness.

Just under a year from the aforementioned event, I was sitting in a team meeting at the Eating Recovery Center (ERC) in Denver, Colorado, an Inpatient and Partial Hospitalization eating disorder program, receiving the news that my insurance company decided to cut me off from treatment prematurely and send me home in the same day. Devastated, I called my family to book a ticket back to New York; we all cried in mourning. My family, my team and myself all acknowledged what a lethal conclusion this was; I was clearly not well enough to complete treatment, and within the following month I became a statistic, relapsing to a new low that shocked my primary care doctors. My insurance denied me further treatment, washing their hands of my existence.

My story isn’t unique. In fact, I share it with 30 million people in the States alone. Many peers I met in treatment aren’t with us any longer, insurance robbing them of vital treatment against doctors’ expert judgments and literally sending them home to die. The battle over insurance infrastructure has divided U.S. politics for some time now, and it embodies a more sinister fight between corporate America and a person’s right to live.

The inappropriate and callous disregard insurance companies have for such a multifaceted and grueling illness is nauseating. Whether they simply want to make the most profit in their business decisions – forget calling their patients anything but investments – or are just obstinately ignorant (unlikely, due to the substantial research done on the disease and proliferate amount of cases that end in tragedy), the way in which insurance companies in this country function are unmistakably killing our friends and family. Relying solely on how a patient affects their revenue, insurance companies are able and financially incentivized to play God. The stratified approach to treatment that is required by such a multifaceted disease is denied in favor of these companies pointing to numerical values – namely BMI – that serves to reinforce eating disorder victims’ fixation with numbers and their correlation with personal worth. What is a patient supposed to make of themselves when even their insurance provider is saying they are “not sick enough” and “too fat for treatment”?

As a world-renowned center, ERC itself emphasizes the importance of a gradual transition to life outside of a facility. As they explain on their website:

Often times, the hardest work begins when a patient discharges from the structured support of an intensive treatment program. Recognizing aftercare planning and recovery-focused post-treatment as vital to creating sustainable recoveries, Eating Recovery Center pays meticulous attention to the discharge plan from the moment of initial contact, and throughout the course of treatment.

But insurance continually denies victims this opportunity, and often their actions in sudden cut-offs that unravel much of the progress made in treatment. Patients relapse within the first few months without adequate support, and being bounced by their insurance company reinforces their anxieties concerning “not being good enough” and being defined by numbers.  Additionally, these people may have suffered for most of their lives – I recall a few patients whose ages ranged from 37-60 years old — and you simply cannot expect half a century of disordered behavior patterns and defragmented neurological pathways to be healed over the course of a few weeks. It’s ridiculous standard that even the most genuine patient cannot achieve, and is proven through tragically repetitive statistics.

In 2014, 60 Minutes released an episode called “Denied,” focusing on the merciless operative of insurance companies that historically tear mental illness patients from treatment against doctors’ orders. Most notably, it follows the actions of Anthem, the second largest American health insurance company, that takes yet another eating disorder patient out of treatment early; this time, a 15-year-old who was forced by their insurance company to complete only half of a twelve-week plan provided by medical experts. Much like my experience, her treatment team argued that “She needs to stay here…She isn’t ready for this.”  Superseding this medical declaration, Anthem denied further treatment and this 15-year-old girl died shortly after, her mother finding her daughter lifeless in her bed. The commentary from her mother between interviewer Scott Pelley is eerie and heartbreaking:

Blue Cross Blue Shield, via A Healthier Michigan / Flickr

Blue Cross Blue Shield, via A Healthier Michigan / Flickr

Nancy West: I was texting her, no response. I got home at 12:30 that day and I found my daughter in bed. She’d been gone for hours. And I just remember running through the house screaming. I couldn’t believe it. My beautiful girl was gone. She was gone.

.…

Scott Pelley: Did it make sense to you that a doctor at the insurance company was making these decisions based on telephone conversations?

Nancy West: No. No, they didn’t observe my daughter. You’re talking about a psychiatrist, a pediatrician, a therapist who observed my daughter on a daily basis. But some nameless, faceless doctor is making this decision. And I was furious. Because basically to me he was playing God with my daughter’s life.

Anorexia is a genetic disease that is so deadly because it co-mingles with other ailments; most commonly, depression and anxiety surface during its progression, but more gut-wrenching and tangible cohorts make it that much deadlier. Diabulimia, more accurately referred to as ED-DMT1, affects up to 1/3 of those with Type 1 Diabetes (ages 15-30) and involves insulin manipulation by patients.  This Russian Roulette of insulin delivery sends diabetics into a dangerous oscillation of hyper and hypoglycemia, blood sugar extremes that carry morbid consequences. Among these complications are damage to the heart, kidney, retina and peripheral nerves; and this adds to the risk of heart failure, osteoporosis and insurmountable complications that come with an eating disorder on its own. Type 1 already harbors serious health risks, but ED-DMT1 can cause a rapid spiral into the deterioration of a patient’s health and further their psychiatric, medical and psychological needs. Heedlessly, insurance companies treat these dual diagnoses with the same brutishness as any other “costly case,” denying and washing their hands of the person in question.

At the end of the day, the current insurance system that the United States legislates prioritizes capital over conscience. Money has a greater value to these looming companies than the Americans they claim to “serve,” abandoning any sense of morality and ethics for the opportunity to gain a dollar. Their legacies are colored crimson by the incalculable people they have left to die.

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