Something seriously messed up just happened to a friend of mine regarding health care.

Not sure I understand the situation completely but I'll try to repeat what she said.

She's been granted SSI/Disability after a many year battle for it. Mostly physical in nature but some mental health issues as well. So she has medicaid and medicare insurance now.

After a long search she found a therapist she loves and has made great progress over eight weeks with her. Her medicaid and/or medicare was paying for this.

Out of the blue she gets a letter telling her that medicaid/medicare has enrolled her in an HMO-Optima I believe-and any of her coverage now has a significant co-pay.

It gets better. This therapist she has made such strides forward with cannot legally see her anymore. Not even if she had the cash to pay it out of pocket. The group the therapist works for presumably is only for uninsured or underinsured patients and my friends new HMO disqualifies her and won't pay for this Doctor because she's not on "The List".

As I said I still don't understand how it is possible that she couldn't see this therapist outside of her HMO's realm but apparently to do that would get her cancelled? The counselor in question tells her that her hands are tied and I guess the therapist was even crying about it. Clearly not happy with what she had to do to my friend.

I've never heard of this before, I'm not up on my medicaid law but how does medicaid end up just handing you over to private insurance without your consent?

Has some shadowy insurance mandate already started taking place and its fucking the people in the greatest need of health care?

Anyone who could shed some light on this or is flabergasted as I am about it please chime in. Its the state of Virginia in question here if that helps. Thanks.
-S

His doctor would not and could not see him - even if I paid for it out of pocket - because we were on TennCare and they didn't take it. Had to take him to a pricey walk-in clinic for some stupid antibiotics (ear infection).

Thankfully, I wasn't out of work long, got insurance, etc. and he's back to seeing his regular doctor.

So, yes, it can and does happen and it's the law in many states.

my insurance choice. I'm a senior and they're smacking their lips...LOL.

And a choice was made for her at a deadline date. Optima Insurance. Yeah. Optimal profits. I'm going to do some research on these bloodsuckers now.

and it sounds like some insurance HMO got a sweetheart deal to take over and make big bucks. What we need to remind every legislator is that private companies are out for profit, not for helping people get better or even to stay well.

Instead she now gets more cost, which she can't bear, and less choice. I thought that was the big argument the rethugs had against public options. Less choice. Bull. Fuckin. Shit.

abolish all for-profit primary health insurance companies. Let them have the niche market of specialists for elective plastic surgery, etc.

<http://www.optimahealth.com/optimahealth/>

but when I had it, I used it. I picked the doctors and facilities I needed off the insurance company's website. If it weren't for the fact that they were listed as providers by my insurance company I never would have heard of them. Most things were paid for at the 90% rate promised, but two rather large bills were covered at 60%. They told me these were out of network providers. It just makes me want to scream.

And now I'm terrified the same thing might happen to me when/if I win my SSI/D appeal hearing (in about a year from now). I too have searched long and hard for a professional around here that I trust and not to be full of myself, but even seemed intelligent enough to analyze me. I've already found out from talking to my new counselor that a few of them flat out lied to me about questions I had.

Just not your choice in mental health therapists. Because we know better than you who you should trust.