Tech Bliss – by Clo S., MSc.
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The popular idea of a “digital detox” is simple enough, “just unplug!”, they say.
But here in the real world, not only is that often not practical for many of us, it may not always even be entirely desirable. The Internet (and our devices with all their bells and whistles) can be a source of education, joy, and connection!
So, how to find out what’s good for us and what’s not, in our daily digital practices? Clo. S. has answers… Or rather, experiments for us to do and find out for ourselves.
These experiments range from the purely practical “try this to streamline your experience” to the more personal “how does this thing make you feel?”. A lot of the experiments will be performed via your digital devices—some, without! Others are about online interpersonal dynamics, be they one-on-one or navigating a world in which it seems everyone is out to get us, our outrage, and/or our money. Still yet others are about optimizing what you do get from the parts of your digital experience that are enriching for you.
As the title suggests, there are 30 experiments, and it’s not a stretch to do them one per day for a month. But, as the author notes, it’s by no means necessary to do them like that; it’s a workbook and reference guide, not a to-do list!
(On the topic of it being a reference guide…There’s also an extensive tools directory towards the end!)
In short: this is a great book for optimizing your online experience—whatever that might mean for you personally; you can decide for yourself along the way!
Click here to get a copy of Tech Bliss: 30 Experiments For Your Digital Wellness today!
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Health Hacks from 20 Doctors
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Doctor Mike’s Approach
You may be used to Tuesday’s expert insights column, where we break down the work or research of a medical expert. Doctor Mike, the creator of the video below, has put us to shame, interviewing 20 experts and condensing it into one, sub 12-minute video.
In short, Doctor Mike has interviewed medical professionals and asked them to share a unique piece of advice, specific to their field, that’s easy to incorporate into your daily routine. He calls them Health Hacks (hey, that sounds similar to our Life Hacks section).
We aren’t going to list out all 20—you’ll have to watch the video for that—but here are a few of our favourites
Toenail Fungus Treatment
Dr. Dana Brems, a podiatrist, reveals that Vicks VapoRub has antifungal properties, and thus can be used on toenails affected by fungus.
Water Intake Myth
Dr. Rena Malik, a urologist, debunks the myth that everyone needs to drink eight glasses of water daily, advising people to drink when thirsty and monitor urine color for hydration.
(You can see what we’ve written on this subject here, as well as here).
Natural Lip Plumper
Dr. Anthony Youn, a plastic surgeon, offers a simple recipe for plumping lips—add a drop or two of food-grade peppermint oil to your lip gloss.
Toothbrushing Technique:
Dr. Winters, an orthodontist, explains that brushing teeth at a 45-degree angle towards the gums is more effective than the common side-to-side method. See our thoughts on this here and here.
Want more tips? Watch them all in the video below:
How was the video? If you’ve discovered any great videos yourself that you’d like to share with fellow 10almonds readers, then please do email them to us!
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Beet “Kvass” With Ginger
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Kvass is a popular drink throughout Eastern Europe, with several countries claiming it, but the truth is, kvass is older than nations (as in: nations, in general, any of them; nation states are a newer concept than is often realized), and its first recorded appearance was in the city state of Kyiv.
This one is definitely not a traditional recipe, as kvass is usually made from rye, but keeping true to its Eastern European roots with (regionally popular) beetroot, it’s nevertheless a great fermented drink, full of probiotic benefits, and this time, with antioxidants too.
It’s a little saltier than most things we give recipes for here, so enjoy it on hot sunny days as a great way to replenish electrolytes!
You will need (for 1 quart / 1 liter)
- 2¾ cups filtered or spring water
- 2 beets, roughly chopped
- 1 tbsp chopped fresh ginger
- 2 tsp salt (do not omit or substitute)
Method
(we suggest you read everything at least once before doing anything)
1) Sterilize a 1-quart jar with boiling water (carefully please)
2) Put all the ingredients in the jar and stir until the salt dissolves
3) Close the lid tightly and store in a cool dark place to ferment for 2 weeks
4) Strain the beets and ginger (they are now pickled and can be enjoyed in a salad or as a kimchi-like snack), pouring the liquid into a clean jar/bottle. This can be kept in the fridge for up to a month. Next time you make it, if you use ¼ cup of this as a “starter” to replace an equal volume of water in the original recipe, the fermentation will take days instead of weeks.
5) Serve! Best served chilled, but without ice, on a hot sunny day.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Making Friends With Your Gut (You Can Thank Us Later)
- What To Eat, Take, And Do Before A Workout
- Ginger Does A Lot More Than You Think
Take care!
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Healing Cracked Fingers
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Question. Suffer from cracked (split) finger tips in the cold weather. Very painful, is there something I can take to ward off this off. Appreciate your daily email.❞
Ouch, painful indeed! Aside from good hydration (which is something we easily forget in cold weather), there’s no known internal guard against this*, but from the outside, oil-based moisturizers are the way to go.
Olive oil, coconut oil, jojoba oil, and shea butter are all fine options.
If the skin is broken such that infection is possible, then starting with an antiseptic ointment/cream is sensible. A good example product is Savlon, unless you are allergic to its active ingredient chlorhexidine.
*However, if perchance you are also suffering from peripheral neuropathy (a common comorbidity of cracked skin in the extremities), then lion’s main mushroom can help with that.
Writer’s anecdote: I myself started suffering from peripheral neuropathy in my hands earlier this year, doubtlessly due to some old injuries of mine.
However, upon researching for the above articles, I was inspired to try lion’s mane mushroom for myself. I take it daily, and have now been free of symptoms of peripheral neuropathy for several months.
Here’s an example product on Amazon, by the way
Enjoy!
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Thinking, Fast and Slow – by Dr. Daniel Kahneman
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We all try to make the best decisions we can with the information available… Don’t we?
Yet, somehow, a survival chance of 90% seems better than a mortality rate of 10%, and as it turns out, we as fallible humans are prey to all manner of dubious heuristics.
Nobel Prize winner Dr. Daniel Kahneman lays out for us two sytems of thought process:
- Fast, intuitive, emotional
- Slow, deliberate, logical
He makes the case for how and why we do need both, but often end up using the wrong one. He notes how the first is required for efficiency, or we would spend all day deciding what socks to wear… The second, meanwhile, is required for high-stakes decisions, but is lazy by nature, and often we don’t engage it when we ought to.
Over the course of many diverse examples, Dr. Kahneman shows how again and again, the second system is slowly cogitating at the back of the class, while the first system is bouncing up and down with its hand in the air saying “I know! I know!”, even when, in fact, it does not know.
For a book largely founded in economics (it’s a massive takedown of the notion of the rational consumer), it is not at all dry, and is very readable in style. It’s engaging throughout, and readers far removed from Wall Street will find plenty of ways it relates to our everyday lives.
Bottom line: if you’d like to avoid making many mistakes in what you’d assumed to be rational decisions, this book is critical reading.
Click here to check out “Thinking, Fast And Slow”, and enjoy the results of better decisions!
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How Nature Provides Us With A Surprisingly Powerful Painkiller
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It’s well-known (at least to regular 10almonds-readers) that seeing nature, ideally green leaves and blue sky, improves our mood by stimulating production of serotonin.
See also: Neurotransmitter Cheatsheet
But it does a lot more.
Reducing the actual signals of pain
Researchers at the University of Vienna have discovered that viewing nature scenes (even if just on video) alleviates physical pain—not just in self-reported subjective assessments, but also by a reduction of the neural activity that signals pain:
❝Pain is like a puzzle, made up of different pieces that are processed differently in the brain. Some pieces of the puzzle relate to our emotional response to pain, such as how unpleasant we find it. Other pieces correspond to the physical signals underlying the painful experience, such as its location in the body and its intensity.
Unlike placebos, which usually change our emotional response to pain, viewing nature changed how the brain processed early, raw sensory signals of pain.
Thus, the effect appears to be less influenced by participants’ expectations, and more by changes in the underlying pain signals❞
This was tested against, varyingly, viewing an urban environment or viewing an indoor environment, neither of which gave the same benefits.
The setup of the experiment is relevant, so…
Matching soundscape accompanied each visual stimulus. The three pain runs had a total duration of 9 min each, during which one environment was accompanied by 16 painful and 16 non-painful shocks. Neuroimaging was used for all parts, and participants were exposed to all environments:
- First, a cue indicating the intensity of the next shock (red = painful, yellow = not painful) was presented for 2000 milliseconds (ms).
- Second, a variable interval of 3500 ± 1500 ms was shown.
- Third, a cue indicating the intensity of the shock was presented for 1000 ms, accompanied by an electrical shock with a duration of 500 ms.
- Fourth, a variable interval of 3500 ± 1500 ms followed.
- Fifth, after each third trial, participants rated the shock’s intensity and unpleasantness at 6000 ms each.
- Sixth, each trial ended with an intertrial interval (ITI) presented for 2000 ms.
They found that as well as the self-assessment reports being as expected (nature scenes reduced subjective experience of pain),
❝In summary, the multivoxel and region of interest analyses converged in showing that pain responses when exposed to nature as compared to urban or indoor stimuli were associated with a decrease in neural processes related to lower-level nociception-related features (NPS, thalamus), as well as in regions of descending modulatory circuitry associated with attentional alterations of pain that also encode sensory-discriminative aspects (S2, pINS).❞
In other words—to the extent that pain can be quantified objectively by neural imaging—the pain was also objectively reduced, much like with a chemical painkiller.
You can read the paper in full, here:
Nature exposure induces analgesic effects by acting on nociception-related neural processing
How to benefit from this
Well, first there is the obvious, “view nature“.
However, note the timescales involved in the testing periods: 2000 milliseconds is two seconds, and that was the intertrial interval used—the equivalent of a washout phase in an interventional trial (but a drug/supplement/diet washout is usually a number of weeks).
The fact that the test periods were a matter of seconds, and the intertrial period was also literally two seconds, this means:
It works quickly, and the effect disappears quickly, too.
In other words: if you want pain relief from nature, the good news is you can get it immediately while viewing nature, and the bad news is that you have to keep viewing nature to continue enjoying the painkilling effect.
So that’s a limitation, but it’s still clearly a very worthy option for a little respite from chronic pain now and again, for example.
Want to learn more?
We’ve written quite a bit about pain management, including:
- Before You Reach For That Tylenol…
- How To Stop Pain Spreading
- How To Dial Down Your Pain
- Managing Chronic Pain (Realistically!)
- Get The Right Help For Your Pain
- The 7 Approaches To Pain Management
- Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)
Take care!
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Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.
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Reporting Highlights
- Progress Denials: Insurers use a patient’s improvement to justify denying mental health coverage.
- Providers Disagree: Therapists argue with insurers and the doctors they employ to continue covering treatment for their patients.
- Patient Harm: Some patients backslid when insurers cut off coverage for treatment at key moments.
These highlights were written by the reporters and editors who worked on this story.
Geneva Moore’s therapist pulled out her spiral notebook. At the top of the page, she jotted down the date, Jan. 30, 2024, Moore’s initials and the name of the doctor from the insurance company to whom she’d be making her case.
She had only one chance to persuade him, and by extension Blue Cross and Blue Shield of Texas, to continue covering intensive outpatient care for Moore, a patient she had come to know well over the past few months.
The therapist, who spoke on the condition of anonymity out of fear of retaliation from insurers, spent the next three hours cramming, as if she were studying for a big exam. She combed through Moore’s weekly suicide and depression assessments, group therapy notes and write-ups from their past few sessions together.
She filled two pages with her notes: Moore had suicidal thoughts almost every day and a plan for how she would take her own life. Even though she expressed a desire to stop cutting her wrists, she still did as often as three times a week to feel the release of pain. She only had a small group of family and friends to offer support. And she was just beginning to deal with her grief and trauma over sexual and emotional abuse, but she had no healthy coping skills.
Less than two weeks earlier, the therapist’s supervisor had struck out with another BCBS doctor. During that call, the insurance company psychiatrist concluded Moore had shown enough improvement that she no longer needed intensive treatment. “You have made progress,” the denial letter from BCBS Texas read.
When the therapist finally got on the phone with a second insurance company doctor, she spoke as fast as she could to get across as many of her points as possible.
“The biggest concern was the abnormal thoughts — the suicidal ideation, self-harm urges — and extensive trauma history,” the therapist recalled in an interview with ProPublica. “I was really trying to emphasize that those urges were present, and they were consistent.”
She told the company doctor that if Moore could continue on her treatment plan, she would likely be able to leave the program in 10 weeks. If not, her recovery could be derailed.
The doctor wasn’t convinced. He told the therapist that he would be upholding the initial denial. Internal notes from the BCBS Texas doctors say that Moore exhibited “an absence of suicidal thoughts,” her symptoms had “stabilized” and she could “participate in a lower level of care.”
The call lasted just seven minutes.
Moore was sitting in her car during her lunch break when her therapist called to give her the news. She was shocked and had to pull herself together to resume her shift as a technician at a veterinary clinic.
“The fact that it was effective immediately,” Moore said later, “I think that was the hardest blow of it all.”
Many Americans must rely on insurers when they or family members are in need of higher-touch mental health treatment, such as intensive outpatient programs or round-the-clock care in a residential facility. The costs are high, and the stakes for patients often are, too. In 2019 alone, the U.S. spent more than $106.5 billion treating adults with mental illness, of which private insurance paid about a third. One 2024 study found that the average quoted cost for a month at a residential addiction treatment facility for adolescents was more than $26,000.
Health insurers frequently review patients’ progress to see if they can be moved down to a lower — and almost always cheaper — level of care. That can cut both ways. They sometimes cite a lack of progress as a reason to deny coverage, labeling patients’ conditions as chronic and asserting that they have reached their baseline level of functioning. And if they make progress, which would normally be celebrated, insurers have used that against patients to argue they no longer need the care being provided.
Their doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment as long as they actually need it, but not so much that the companies prematurely cut them off from care. And when insurers demand that providers spend their time justifying care, it takes them away from their patients.
“The issues that we grapple with are in the real world,” said Dr. Robert Trestman, the chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine and chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing. “People are sicker with more complex conditions.”
Mental health care can be particularly prone to these progress-based denials. While certain tests reveal when cancer cells are no longer present and X-rays show when bones have healed, psychiatrists say they have to determine whether someone has returned to a certain level of functioning before they can end or change their treatment. That can be particularly tricky when dealing with mental illness, which can be fluid, with a patient improving slightly one day only to worsen the next.
Though there is no way to know how often coverage gets cut off mid-treatment, ProPublica has found scores of lawsuits over the past decade in which judges have sharply criticized insurance companies for citing a patient’s improvement to deny mental health coverage. In a number of those cases, federal courts ruled that the insurance companies had broken a federal law designed to provide protections for people who get health insurance through their jobs.
Reporters reviewed thousands of pages of court documents and interviewed more than 50 insiders, lawyers, patients and providers. Over and over, people said these denials can lead to real — sometimes devastating — harm. An official at an Illinois facility with intensive mental health programs said that this past year, two patients who left before their clinicians felt they were ready due to insurance denials had attempted suicide.
Dr. Eric Plakun, a Massachusetts psychiatrist with more than 40 years of experience in residential and intensive outpatient programs, and a former board member of the American Psychiatric Association, said the “proprietary standards” insurers use as a basis for denying coverage often simply stabilize patients in crisis and “shortcut real treatment.”
Plakun offered an analogy: If someone’s house is on fire, he said, putting out the fire doesn’t restore the house. “I got a hole in the roof, and the windows have been smashed in, and all the furniture is charred, and nothing’s working electrically,” he said. “How do we achieve recovery? How do we get back to living in that home?”
Unable to pay the $350-a-day out-of-pocket cost for additional intensive outpatient treatment, Moore left her program within a week of BCBS Texas’ denial. The insurer would only cover outpatient talk therapy.
During her final day at the program, records show, Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. She was barely eating or sleeping.
A few hours after the session, Moore drove herself to a hospital and was admitted to the emergency room, accelerating a downward spiral that would eventually cost the insurer tens of thousands of dollars, more than the cost of the treatment she initially requested.
How Insurers Justify Denials
Buried in the denial letters that insurance companies send patients are a variety of expressions that convey the same idea: Improvement is a reason to deny coverage.
“You are better.” “Your child has made progress.” “You have improved.”
In one instance, a doctor working for Regence Blue Cross and Blue Shield of Oregon wrote that a patient who had been diagnosed with major depression was “sufficiently stable,” even as her own doctors wrote that she “continued to display a pattern of severe impairment” and needed round-the-clock care. A judge ruled that “a preponderance of the evidence” demonstrated that the teen’s continued residential treatment was medically necessary. The insurer said it can’t comment on the case because it ended with a confidential settlement.
In another, a doctor working for UnitedHealth Group wrote in 2019 that a teenage girl with a history of major depression who had been hospitalized after trying to take her own life by overdosing “was doing better.” The insurer denied ongoing coverage at a residential treatment facility. A judge ruled that the insurer’s determination “lacked any reasoning or citations” from the girl’s medical records and found that the insurer violated federal law. United did not comment on this case but previously argued that the girl no longer had “concerning medical issues” and didn’t need treatment in a 24-hour monitored setting.
To justify denials, the insurers cite guidelines that they use to determine how well a patient is doing and, ultimately, whether to continue paying for care. Companies, including United, have said these guidelines are independent, widely accepted and evidence-based.
Insurers most often turn to two sets: MCG (formerly known as Milliman Care Guidelines), developed by a division of the multibillion-dollar media and information company Hearst, and InterQual, produced by a unit of UnitedHealth’s mental health division, Optum. Insurers have also used guidelines they have developed themselves.
MCG Health did not respond to multiple requests for comment. A spokesperson for the Optum division that works on the InterQual guidelines said that the criteria “is a collection of established scientific evidence and medical practice intended for use as a first level screening tool” and “helps to move patients safely and efficiently through the continuum of care.”
A separate spokesperson for Optum also said the company’s “priority is ensuring the people we serve receive safe and effective care for their individual needs.” A Regence spokesperson said that the company does “not make coverage decisions based on cost or length of stay,” and that its “number one priority is to ensure our members have access to the care they need when they need it.”
In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.
“It’s very hard when you come up against all these rules that are kind of setting you up to fail the patient,” said Brittainy Lindsey, a licensed mental health counselor who worked at the Anthem subsidiary Beacon and at Humana for a total of six years before leaving the industry in 2022. In her role, Lindsey said, she would suggest approving or denying coverage, which — for the latter — required a staff doctor’s sign-off. She is now a mental health consultant for behavioral health businesses and clinicians.
A spokesperson for Elevance Health, formerly known as Anthem, said Lindsey’s “recollection is inaccurate, both in terms of the processes that were in place when she was a Beacon employee, and how we operate today.” The spokesperson said “clinical judgment by a physician — which Ms. Lindsey was not — always takes precedence over guidelines.”
In an emailed statement, a Humana spokesperson said the company’s clinician reviewers “are essential to evaluating the facts and circumstances of each case.” But, the spokesperson said, “having objective criteria is also important to provide checks and balances and consistently comply with” federal requirements.
The guidelines are a pillar of the health insurance system known as utilization management, which paves the way for coverage denials. The process involves reviewing patients’ cases against relevant criteria every handful of days or so to assess if the company will continue paying for treatment, requiring providers and patients to repeatedly defend the need for ongoing care.
Federal judges have criticized insurance company doctors for using such guidelines in cases where they were not actually relevant to the treatment being requested or for “solely” basing their decisions on them.
Wit v. United Behavioral Health, a class-action lawsuit involving a subsidiary of UnitedHealth, has become one of the most consequential mental health cases of this century. In that case, a federal judge in California concluded that a number of United’s in-house guidelines did not adhere to generally accepted standards of care. The judge found that the guidelines allowed the company to wrongly deny coverage for certain mental health and substance use services the moment patients’ immediate problems improved. He ruled that the insurer would need to change its practices. United appealed the ruling on grounds other than the court’s findings about the defects in its guidelines, and a panel of judges partially upheld the decision. The case has been sent back to the district court for further proceedings.
Largely in response to the Wit case, nine states have passed laws requiring health insurers to use guidelines that align with the leading standards of mental health care, like those developed by nonprofit professional organizations.
Cigna has said that it “has chosen not to adopt private, proprietary medical necessity criteria” like MCG. But, according to a review of lawsuits, denial letters have continued to reference MCG. One federal judge in Utah called out the company, writing that Cigna doctors “reviewed the claims under medical necessity guidelines it had disavowed.” Cigna did not respond to specific questions about this.
Timothy Stock, one of the BCBS doctors who denied Moore’s request to cover ongoing care, had cited MCG guidelines when determining she had improved enough — something judges noted he had done before. In 2016, Stock upheld a decision on appeal to deny continued coverage for a teenage girl who was in residential treatment for major depression, post-traumatic stress disorder and anxiety. Pointing to the guidelines, Stock concluded she had shown enough improvement.
The patient’s family sued the insurer, alleging it had wrongly denied coverage. Blue Cross and Blue Shield of Illinois argued that there was evidence that showed the patient had been improving. But, a federal judge found the insurer misstated its significance. The judge partially ruled in the family’s favor, zeroing in on Stock and another BCBS doctor’s use of improvement to recommend denying additional care.
“The mere incidence of some improvement does not mean treatment was no longer medically necessary,” the Illinois judge wrote.
In another case, BCBS Illinois denied coverage for a girl with a long history of mental illness just a few weeks into her stay at a residential treatment facility, noting that she was “making progressive improvements.” Stock upheld the denial after an appeal.
Less than two weeks after Stock’s decision, court records show, she cut herself on the arm and leg with a broken light bulb. The insurer defended the company’s reasoning by noting that the girl “consistently denied suicidal ideation,” but a judge wrote that medical records show the girl was “not forthcoming” with her doctors about her behaviors. The judge ruled against the insurer, writing that Stock and another BCBS doctor “unreasonably ignored the weight of the medical evidence” showing that the girl required residential treatment.
Stock declined to comment. A spokesperson for BCBS said the company’s doctors who review requests for mental health coverage are board certified psychiatrists with multiple years of practice experience. The spokesperson added that the psychiatrists review all information received “from the provider, program and members to ensure members are receiving benefits for the right care, at the right place and at the right time.”
The BCBS spokesperson did not address specific questions related to Moore or Stock. The spokesperson said that the examples ProPublica asked about “are not indicative of the experience of the vast majority of our members,” and that it is committed to providing “access to quality, cost-effective physical and behavioral health care.”
A Lifelong Struggle
A former contemporary dancer with a bright smile and infectious laugh, Moore’s love of animals is eclipsed only by her affinity for plants. She moved from Indiana to Austin, Texas, about six years ago and started as a receptionist at a clinic before working her way up to technician.
Moore’s depression has been a constant in her life. It began as a child, when, she said, she was sexually and emotionally abused. She was able to manage as she grew up, getting through high school and attending Indiana University. But, she said, she fell back into a deep sadness after she learned in 2022 that the church she found comfort in as a college student turned out to be what she and others deemed a cult. In September of last year, she began an intensive outpatient program, which included multiple group and individual therapy sessions every week.
Moore, 32, had spent much of the past eight months in treatment for severe depression, post-traumatic stress disorder and anxiety when BCBS said it would no longer pay for the program in January.
The denial had come to her without warning.
“I was starting to get to the point where I did have some hope, and I was like, maybe I can see an actual end to this,” Moore said. “And it was just cut off prematurely.”
At the Austin emergency room where she drove herself after her treatment stopped, her heart raced. She was given medication as a sedative for her anxiety. According to hospital records she provided to ProPublica, Moore’s symptoms were brought on after “insurance said they would no longer pay.”
A hospital social worker frantically tried to get her back into the intensive outpatient program.
“That’s the sad thing,” said Kandyce Walker, the program’s director of nursing and chief operating officer, who initially argued Moore’s case with BCBS Texas. “To have her go from doing a little bit better to ‘I’m going to kill myself.’ It is so frustrating, and it’s heartbreaking.”
After the denial and her brief admission to the hospital emergency department in January, Moore began slicing her wrists more frequently, sometimes twice a day. She began to down six to seven glasses of wine a night.
“I really had thought and hoped that with the amount of work I’d put in, that I at least would have had some fumes to run on,” she said.
She felt embarrassed when she realized she had nothing to show for months of treatment. The skills she’d just begun to practice seemed to disappear under the weight of her despair. She considered going into debt to cover the cost of ongoing treatment but began to think that she’d rather end her life.
“In my mind,” she said, “that was the most practical thing to do.”
Whenever the thought crossed her mind — and it usually did multiple times a day — she remembered that she had promised her therapist that she wouldn’t.
Moore’s therapist encouraged her to continue calling BCBS Texas to try to restore coverage for more intensive treatment. In late February, about five weeks after Stock’s denial, records show that the company approved a request that sent her back to the same facility and at the same level of care as before.
But by that time, her condition had deteriorated so severely that it wasn’t enough.
Eight days later, Moore was admitted to a psychiatric hospital about half an hour from Austin. Medical records paint a harrowing picture of her condition. She had a plan to overdose and the medicine to do it. The doctor wrote that she required monitoring and had “substantial ongoing suicidality.” The denial continued to torment her. She told her doctor that her condition worsened after “insurance stopped covering” her treatment.
Her few weeks stay at the psychiatric hospital cost $38,945.06. The remaining 10 weeks of treatment at the intensive outpatient program — the treatment BCBS denied — would have cost about $10,000.
Moore was discharged from the hospital in March and went back into the program Stock had initially said she no longer needed.
It marked the third time she was admitted to the intensive outpatient program.
A few months later, as Moore picked at her lunch, her oversized glasses sliding down the bridge of her nose every so often, she wrestled with another painful realization. Had the BCBS doctors not issued the denial, she probably would have completed her treatment by now.
“I was really looking forward to that,” Moore said softly. As she spoke, she played with the thick stack of bracelets hiding the scars on her wrists.
A few weeks later, that small facility closed in part because of delays and denials from insurance companies, according to staff and billing records. Moore found herself calling around to treatment facilities to see which ones would accept her insurance. She finally found one, but in October, her depression had become so severe that she needed to be stepped up to a higher level of care.
Moore was able to get a leave of absence from work to attend treatment, which she worried would affect the promotion she had been working toward. To tide her over until she could go back to work, she used up the money her mother sent for her 30th birthday.
She smiles less than she did even a few months ago. When her roommates ask her to hang out downstairs, she usually declines. She has taken some steps forward, though. She stopped drinking and cutting her wrists, allowing scar tissue to cover her wounds.
But she’s still grieving what the denial took from her.
“I believed I could get better,” she said recently, her voice shaking. “With just a little more time, I could discharge, and I could live life finally.”
Kirsten Berg contributed research.
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