// to whom it may concern (diane/insurance)
| 10/06/2003 - 2:47 a.m. |

this first long email is very repetitive of other recent entries, but a decent summary too i suppose.
and the other email exchanges are pretty boring, but eh, i just like to post everything here, just because. heh.

anyways, the point of it all is the letter (way down towards the bottom, just 1 short email beneath it, if ya wanna skip on down) Diane wrote for the insurance company, which is pretty much...right on.
documents/describes pretty accurately, albeit in a dry and 'clinical' manner, the complete deterioration of my mind and my life in the past 2 years through to their current beyond-pathetic states...

so, uh, happy reading...



Email TO Diane, Tues 9-30-03, 11:43pm, Subject: insurance mess/help needed (�and some other news too)
Hi Diane,

Well, if you were wondering what the hell ever happened with Renfrew, the answer is still absolutely nothing. And that would be because right now, I have NO insurance.

Actually, I haven't had any for a YEAR. Yeah.
My coverage under my mom's policy was terminated when I turned 25 as is the norm.
Now why my mom was under the impression that it would be otherwise in my case and how exactly it went 'unnoticed' and such for all this time, well its a whole other story...

The important thing right now is that we (my mom and I) are working on getting my coverage reinstated and retroactively so, and I will be needing some documentation from you for that purpose.

As it turns out there *is* a clause in her policy that provides for continued coverage to a child, regardless of age, who is unmarried, "incapable of self-support," dependent on the parent for over 1/2 of their support, and whose "disability commenced prior to attaining 19 years of age."

And so several weeks ago we submitted to B.C. an "Application To Continue Coverage For Handicapped Dependent Child" (oh don't I love how that sounds *eyerollsss*).

This was just a relatively brief form, the main section of which I had completed by Dr. McR. I think my mom wrote and attached a letter to it as well.

Then she got a very short and vaguely worded form letter that approval was still pending and some more info was required. Naturally it took a while but she was finally able to get an answer as to what they wanted. One is a long-term mental health/treatment history and it is sufficient that it be from her and I--I had already put together something fairly comprehensive, for McR.'s reference originally, so I just need to make a few minor adjustments, make it more "formal" and that should cover that. This is essentially to show that my "disability commenced prior to attaining 19 years of age", has required continued and to various extents intensive, treatment, etc., etc.

What I need from you (and apparently more extensively from McR. than the info he first provided--will be giving him a call tomorrow) is:
--a summary of my "condition" in my past year+ to present (wellll, as close to currently as possible I guess)...
--...and why I am "incapacitated" at this time.

The latter basically being defined as why/how I am/have been unable to work or attend school AND therefore was my mother's dependent at the time coverage was terminated (i.e., Sept '02 when I turned 25) and continue to be AND therefore should be reinstated (including retroactively) on her policy.

Soooo...not sure what other information or anything else you may want/need or how exactly to work this???
I guess if you have (access to) a fax machine that would be good.
Obviously we're hoping to be able to submit all this stuff as soon as possible...

Many thanks in advance for your assistance in this (er, i hope, heh)--
M.


~~~~~
An addendum here I guess as to what's been going on with me otherwise.
Well, basically, very little that falls outside the heading of same old bullshit...
Until this past week that is.
Wow.

The background was set last Monday when my aunt J. (who I've been staying with) comes out of nowhere with this melodramatic declaration (to my mother, *not* me, and over the phone from work mind you) that she wanted me out of her house by the following week.
Well then.
I will surely admit to being a difficult person to live with and thats in the best of times (and I certainly knew the current arrangement was not feasible for very long-term), but as she eventually acknowledged she is hardly a model of emotional stability right now, is feeling super-stressed by any # of things, most of them having nothing to do with me, but I was the lucky target of her, uh, little SNAPping 'episode', heh.
All kinds of other details about the whole ridiculous situation and how it progressed through the week, but in the end mostly irrelevant.

[[Although I must share one little anecdote that I'm sure you will see the humor in, hahah--
my immediate reaction early Monday evening when my mom called to inform me, alone at my aunt's house at the time, of the conversation she'd just had???
Well I chucked a bunch of stuff in my car and got the fuck out of there *of course*
Duh.
Stayed the night by myself in a motel too.
Ya know, hadn't "run away" from anywhere in a while, needed to get my fix, LOL.]]

ANYWAYS, fast-forward to Saturday afternoon when my mom and I are planning to go apt-hunting for me.
So she picks me up...
...and tells me that my father had that morning offered to move out of the house if I wanted to come live there with my mom.

Apparently at some point in the past year, they had actually like, communicated!!!, and made the mutual acknowledgement that it was only a matter of time before they did actually separate and eventually divorce. Probably the only reason that my father had not already moved out was my mom's employment status.
(Which right now remains the same, still at the Mn. temp job, but there is a good possiblity that she will be getting a decent-enough offer for a permanent position there in the near-future. *fingers-crossed*)

Took a uh, moment or two for me to take it in obviously, but then very little discussion really for me to say, "well, ok. let's do it." All things considered, it really does make the most sense (financially, practically, emotionally, etc.) and for ALL of us I think...

And so it ultimately took all of an hour or so for it to be determined that:
1. (finally) my parents are officially separating
2. asap basically, my father is moving out of the house he and my mother have both lived in for 26+ years, and
3. i am moving (back) in to said house that I have not spent a single night in for a good 7 years.

So yeah. In many ways, not exactly surprising...yet its still all of a 'wow...just wow' nature too.
Right now, don't know how all this is going to progress, in what time frame exactly, what to expect, etc...but if nothing else, I figure it should be interesting, eh??
~~~~~



Reply FROM Diane, Wed 10-01-03, 3:47pm
M.
I will write something for the insurance company, but I need some more information. First, I do have a FAX and can send it to you or to the insurance company, but obviously I need a phone number. If I'm to send it directly to the insurance company I need the name of the person, the name of the company, etc. You should also know that a FAX is not at all protected and there is no way to know who will see the FAX besides the intended person. I almost never agree to send one to a company directly because I can't assure confidentiality. You are asking for highly personal information so you decide. If you are in a big hurry then I can send it to the company.

Secondly, I need another formal consent from you like the last one, but I need it to say that you give me permission to release information about the course of treatment, diagnosis and history to whatever the name of the insurance provider is.

What I will write is basically a short description of when you began and ended treatment with me, your condition while in treatment, what I know of your history of treatment as it relates to my treatment of you and diagnoses. I won't include unnecessary details of your life or therapy, but I will describe your depression and eating disorder.

Once I have the release from you and have written what you need I will FAX it. I won't have time to write it until tonight, however, so the earliest time I could send it would be late Wednesday night or Thursday.

Best,
Diane



Email TO Diane, Wed 10-01-03, 10:57pm, Subject: the additional info
Diane,

You can fax it directly to me at this #: [edited] and my mom and I will submit the various documents or whatever all at once.
Though I doubt we'll actually have it all put together before next week.
Actually if you could additionally send me a copy by snail-mail?, just in case of well-who-knows, that would be good...
[edited]

Here's my consent statement...

-----
[lalala]
-----

Oh, and f.y.i., the ED dianosis has already been submitted as "EDNOS"
;)

Much thanks,
M.



Reply FROM Diane, Wed 10-01-03, 11:01pm
OK, got the info. I will get it to you by the end of the week. Good luck.
Diane



Email FROM Diane, Thu 10-02-03, 11:47pm, Subject: info you need
M.
I've basically written the letter, but I'll have to double check a few details after I've been to my office tomorrow and then I'll fax it. I want to make sure it's what you need, though. Since the point of this is to get you insurance, I really focused on your difficulties and not much on your strengths -- it is tricky to strike the right balance -- I made sure to say more than once that you were dependent on your mother and not functioning well. I said little about the treatment itself -- more about your condition. I diagnosed you with Major Depression and EDNOS. Is that what you were looking for from me?

In addition, I imagine it might not feel great for you to read this letter as it is a rather narrow view of you. I didn't want to misrepresent you, but to make a case for your need for treatment. If there is something in particular that needs to be included, let me know. I want the diagnosis to be in agreement with McR. as well. Did he give you any other Axis I besides the EDNOS?

Diane



Reply TO Diane, Fri 10-03-03, 12:28am
Diane,
All of it sounds good...wellll, what I *think* is needed and was looking for at least.
And the diagnoses are the same as McR.:
1--Major Depression (i think the only specifier he put was recurrent)
2--EDNOS

As for how I might feel about it...*shrug*
I know the drill, I know what the purpose of this stuff is...and besides, at this point, a "narrow" view is probably a pretty truthful one.
so did i say *shrug*? heh.

M.



Letter faxed from Diane, Fri 10-03-03, 12:01pm--
Re: Request for documentation for insurance carrier
To Whom It May Concern:

The following is meant to document M.C.�s psychological condition during the period of time I provided outpatient psychotherapy to her. I saw Ms. C from January 2002 through July of 2003 at a frequency of 1 to 3 times per week. Her presenting complaint was a worsening depressive episode that left her unable to concentrate, complete her schoolwork, or interact socially with friends.

Additionally, Ms. C noted that she was having trouble eating and was losing weight. This is significant because she has a long history, beginning in high school, of anorexic and bulimic behavior. As noted in other materials submitted to you, Ms. C has had several hospitalizations and quite a bit of outpatient treatment related to her eating disorder.

Ms. C�s depression and eating disorder both worsened considerably during the 19 months I treated her. Her functioning deteriorated and her depression became more vegetative. She took a leave of absence from graduate school and essentially stopped most activity and social contact. She slept extremely long hours and was unable to look for a job, complete her incomplete schoolwork or maintain relationships. Once Ms. C took a leave from school (August 2002) and was no longer receiving financial aid, her mother supported her entirely. Her depression deepened, and the lack of structure or meaningful activity in her life only served to reinforce her sense of hopelessness and despair. Her eating disorder took on more importance as she engaged in a variety of binge/purge and starving behaviors. In fact, in the final months of treatment she became dangerously underweight and the urgency of her situation became the focus of attention. In my view, the combination of her severe depressive episode and her malnourishment led her to function at a level far below that which she is capable.

As noted by her psychiatrist, she has been tried on a series of anti-depressant and mood stabilizing medications to little or no effect. Her eating disorder is quite severe and at the termination of treatment she was starving herself for days and weeks at a time. Because she refused inpatient treatment and I felt outpatient treatment was no longer appropriate, Ms. C terminated her treatment with me and returned to live in her hometown near her family.

Though Ms. C is clearly a very bright, articulate and in some ways resilient individual, in my estimation she suffers from both a treatment refractory depression and a severe eating disorder (see DSM IV diagnosis below). At the time she terminated treatment (July, 2003), she had difficulty completing the tasks of daily living such as cooking, feeding herself, cleaning her house, paying bills, assuming responsibility for her finances and maintaining social contacts. She had been under the full financial support of her mother for the previous year, and it seemed unlikely to me she would recover to her higher level of functioning without intensive inpatient treatment.

DSM IV Diagnosis:
Axis I:
296.33--Major Depressive Disorder, Recurrent � Severe without psychotic Features
307.50--Eating Disorder NOS (all criteria for Anorexia Nervosa met with the exception of cessation of menses).

I hope the above information is adequate. Please contact me if I can be of further help.

Sincerely,



Email to Diane, Sun, 10-05-03, 9:57pm, Subject: got it & thanks
Diane,
Just wanted to confirm that I got the fax on Friday and the letter looks good (or whatever).

My mom also read it today and thought it was "excellent" and she "really appreciates" your help in this. For whatever that is worth

[[Of course, if it were for some other purpose, I would be arguing about just how many criteria for AN I actually meet and 'severity' and the usual blahblahblah, but I'm sure you know that, heh. Just saying so here for the sake of I dunno, being "consistent" or something.]]

So yeah. Will let you know what happens...

Thanks again,
M.