In June of 2009 I was admitted into the partial hospitalization program at The Center for Balanced Living in Columbus. The few months I was in their care in PHP were intense, but they saved my life. I learned about the disease I was diagnosed with and they helped me build a solid foundation for a successful life in recovery. For the last 11+ years I have received therapy, medication management services, and nutrition services from them. As I grew stronger in my recovery, the frequency of appointments for all services became less and less. I made amazing connections with my therapists there over the years, and as they got promotions I would start with a new therapist. The last time I connected with a therapist really well, she told me she was leaving to be in independent practice. The work we have done together and the trust I have in her was worth so much to be that I decided to transfer my therapy services in order to stay with her. I still received nutrition services as needed through The Center and regular quarterly visits with my Nurse Practitioner to monitor my meds.
Recently, The Center for Balanced Living was taken over by The Emily Program. My initial reaction was bittersweet as the place that had become a "home" for me was changing and we all know how well I do with change. Then, I found out that so many employees that had been with The Center since way before I began treatment were let go so The Emily Program could use their own people. This was the first thing that upset me. Why couldn't they just transition the payroll employees to their new system? Why couldn't the nutritionist that had been there since the opening of The Center for Balanced Living stay and continue working with the patients that trust her? It just seemed like what was best for the patients was no longer coming first.
Then, on one of my visits with my NP, I was told that I could no longer receive services from her for med management unless I was also on the case load of a nutritionist. No big deal, I thought. It had been a while since I had met with mine and it would be good for me to touch base with her anyway. I was slightly irritated though, as nutrition services are not covered by many insurances, mine included, so every time I needed to meet with her I had to pay a pretty penny out of pocket. So I called to see how frequently I needed to make appointments in order to check this new box of eligibility for The Emily Program. Then, the next visit with my NP was a different story. Now, in order for me to have my meds managed through my NP I had to have nutrition AND meet with one of their therapists regularly. This was the straw that broke the camels back. I was PISSED. Here is where the processing needed to happen. I am going to do the best I can to explain why this was such an irritating thing for me.
More services = more $$$$. My initial thought that all The Emily Program cared about was money, was seeming to be more and more valid. By requiring me to receive ALL THREE services means more money for them. Insurance claims and copays. The fact that I only need to see a NP and nutritionist quarterly and a therapist as needed because I am so strong in my recovery is something I should be celebrating and proud of. I should not be denied any one of these services because I do not need them around the clock.
Being told I can't get my antidepressants and anxiety meds through my NP because I don't also need regular therapy and nutrition services sends me the message that I am not SICK ENOUGH to get continued care. Sure, I could get the same medications through my primary care physician, but here's the thing. There are many, many, many, side effects that can occur with these types of medication. I have chosen to continue getting my medication through my treatment center because they are specially trained in eating disorders. They know the ins and outs of what meds are good for ED and which can cause triggering side effects. They understand more about the chemicals in my brain because it's what they do and study every day. I absolutely love my PCP, she's a close family friend, but she hasn't spent her medical career studying eating disorders, they have.
Look, I admire The Emily Program's focus on providing wrap around services to their patients. However, they need to understand, and should already understand, that eating disorders and eating disorder recovery is not one size fits all. Recovery is not linear. Just because I am smooth sailing right now in recovery and only need occasional visits, does not mean that I won't hit rock bottom in a month and need their help. I should be able to depend on them when I need them and not be turned away because I choose to stay with my therapist that I trust to open up to. They should understand that the relationship between patient and therapist is a sacred one. It takes time to build trust and safety and when you find it, you don't want to change just to meet some corporate check box. If seeing my therapist in her independent practice setting is what is best for my recovery, then they should understand and support that, not turn their back on me because my insurance dollars are going to a therapist that is not their own.
I learned very early on in my treatment that my eating disorder would be something I would likely have to manage for the rest of my life. Some people recover and never have issues again, however most people have to manage their disease the rest of their lives. It gets easier to manage once you learn more about your triggers, coping strategies, and about yourself, but it is something that you always have to keep in check. This blog is a testament to how 10+ years in recovery can be a roller coaster. Like I said earlier, recovery is not linear and because of that, required services and frequency of services should not be expected to be linear.
It makes no sense that I should have to pay out of pocket to see a nutritionist when I have nothing I need to talk about with her. Why would I drive an hour to a 30 minute appointment to tell her everything is going well and that I am meeting my meal plan 100%, pay nearly $100 out of pocket for that 30 minute appointment (which ends up being 10 minutes because there is nothing to discuss) and drive back another hour? Just so I can continue to get the medicine I need in order to maintain my strong recovery? Not only does that say to me "you aren't sick enough" but it also says "we want your money for things you don't need" and "if you don't do this, then we will wait until you're sick enough and need us, then we will get your money!"
I want to give them the benefit of the doubt and say that their complete idiotic policies are to ensure people with eating disorders get the adequate care they need and deserve. That their hearts are in the right places. But it is just too damn hard for me to believe that right now. "Adequate care" looks different for everyone dependent on where they are in recovery. Instead, I have basically received a break up phone call with the facility I have given years of my life and money to, worked hard to fundraise money for, just because I don't want to leave the therapist I love and trust, and pay money I don't need to pay for services I don't currently need.
This has been a difficult thing for me to process. I have cried, been mad, commented a smart ass comment on The Emily Program's instagram page, and then became ignited with more passion for advocacy out of my anger. I debated using the actual names of the treatment centers in this post, but I feel like it is fair. If that is how you are going to run your program, then you need to understand how it affects the people you are claiming to be helping. Eating disorder treatment is already something that is hard to come by. I have always considered myself blessed to live in driving distance to a great treatment center, but now I am being turned away like so many people have. Many people are turned away because of their lack of ability to pay for the services, and others are like me and "not sick enough".
I am still angry, sad, disheartened, and discouraged by their entire situation. I worry about others like me that are now finding themselves in this situation. It shouldn't be like this. It shouldn't be this hard.
To all my warriors out there-
<3 Stay Strong and Beautiful
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