Eating disorders insurance coverage – and actually getting part of your expenses paid for

According to national surveys, approximately 30 million people will experience an eating disorder throughout their life. These illnesses are life threatening (and even the third cause of death for women in America) and involve mental and physical aspects that both have to be equally seriously treated. The earlier the diagnosis, the more chances of recovery a patient has. In any case, these illnesses cannot go untreated: they necessitate important medical attention, and in a lot of cases this involves full time hospitalization, also known as inpatient care. If he or she can pay.

The American Psychiatric Association distinguishes between five levels of care when it comes to treating eating disorders. First are three levels of outpatient care going from appointments with a psychiatrist to a partial hospitalisation, also known as full day outpatient care. On a fourth level is residential treatment and on a fifth inpatient treatment, which involves the patient being locked up in a specialized treatment center.These levels are gradual and they are meant to respond in the best way possible to the specificities of each patient’s case. At least on paper.

The National Eating Disorder Association (NEDA) has extensive documentation explaining how a general care provider usually decides on which level of care would best fit a patient and accurately respond to its medical needs. The text provided by the association reads, as one of its first points:

« The intensity and duration of the treatment depends on:

  • Insurance coverage limits and ability to pay for treatment »

In reality, money often comes before a patient’s medical needs. Obtaining coverage for eating disorder treatments is paved with obstacles and mentally exhausting for the families of patients who already have to go through their loved one’s illness (when patients are lucky enough to have people caring about them, and families willing to take the time to help). Getting an insurance provider to reimburse these types of medical expenses often involves having to make appeals and calling the insurer multiple times, being « persistent, assertive and rational ». It also involves getting as much information on the plan as possible, even if this usually involves reading the full description of the plan and « this document may be longer than a hundred pages », states once again the NEDA. What about those who do not have the legal literacy to understand what is at stake in those documents? Those who do not have parents or family to take care of the paperwork for them? The NEDA also stresses the usefulness of hiring an attorney to help with the case. What about those who cannot afford legal representation, as they are additionally most likely to be the ones who cannot afford care in the first place?

All in all, in the United States, getting access to a decent and appropriate treatment and partial coverage for the expenses attached to it appears almost as complicated as getting a PhD.

Insurers do not cover eating disorder expenses the same way. On paper, the situation is better than it what it used to be prior to December 2016, date at which a new law concerning the obligation for insurance providers to cover equally for physical and mental expenses passed. However, in reality, getting an insurer to reimburse these expenses is still very complicated, and no insurance plan will cover them entirely. Most plans propose to cover 12 psychiatric visits per semester. In many cases, these are of course not sufficient. Inpatient care costs on average 30 000$ a month, and many parents have so far had to find ways to pay for this through other means, among which the dilapidation of their retirement savings.

Primary care providers are the ones deciding over what is the most adapted treatment, considering their patient’s condition and financial resources. A treatment center is chosen according to the insurer’s affiliations with those types of structures. The care provider also discusses with the insurer, and even if the insurer does agree to pay part of the expenses, demands for extensions have to be made on a regular basis. Most of the time, insurance providers agree on covering several days of treatment, when inpatient treatments often requires the stay to be a few months before they start being effective. Moreover, the insurer can deny further care if it notices a « lack of progress in treatment », which manifests itself either by the patient « not restoring weight », « no reduction in behaviors », or a« lack of motivation in treatment ». However, eating disorders are also mental issues, and the patient is not always willing to get better  in the first place as he is mentally caught in a vicious circle. It is often the families who have to take action, and take their love one to see a care provider or a psychiatrist.

In anyway, being met by a refusal of even partial coverage for those medical expenses is stressful, and puts an additional burden on already worried families. Here are three ways to try to unlock your situation, and one way in which the system could be amended – but this last element requires an increase in awareness, and would need people to bring the issue in the spotlight for actors to take on the issue.

NEDA: A first step towards getting your insurer to cover for part of your expenses

Denial of coverage or refusal to provide further care can of course, be appealed. As odd as it may sound, these denials are actually to be expected. Families and patients should not feel desperate by these steps that are most of the time mandatory obstacles before getting partial financial coverage. NEDA provides extensive documentation, available to families for free. This documentation is highly valuable, and needs to be checked if needing guidance on how to make an appeal . NEDA proposes models of letters (p.53) that can be sent to insurers, and phone call scripts worth consulting (p.60).

NEDA also offers a helpline (1-800-931-2237). However, this helpline is not meant to provide help on extensive case to case solutions. If requesting a lawyer to manage your case is too expensive, you should consider taking the next step: contacting your representative in Congress.

Your representative: don’t be afraid to take the step – especially if you are covered by Medicare

Contacting a US representative is most efficient if your medical coverage is Medicare / Medicaid, as these are federal agencies. Your congressman might not have as much leverage if your health care plan is private.

You can find your own representative here, and should try to give a phone call to its cabinet in order to clearly expose your problem. You should not try to contact more than one of your representatives at the time, as this will not make your request process faster. Stressing the urgency of your request might be worth a try, but remember that in most cases you will have to be patient. However, cabinet members are hired to serve the representatives’ constituants, and these are issues they are here tackle. It can just take time.

The grant option

If you are unable to pay for the very out of the pocket cost of the coverage, which can rise up to 6000$ depending on your health plan, (such as for Blue cross Blue Shield), one solution might be to request a grant. Non profit associations, most of the times funded by family members of deceased patients, do propose such awards on return of application. Here is one you can contact to ask for financial help. You will have to return an application form, that can be downloaded here.

Moving forward

In a perfect world there would, of course, be universal and full healthcare coverage (if in search of an example, most european countries do so and it works -and Scandinavian countries are particularly good at this.) However, this is highly unlikely to happen in a near / far future.

What could be done, then? Private foundations should step in, and consider providing fundings to create structures that could provide eating disorder treatment for free. For the most part, these illnesses target young people, who have a future and a role to play in our society. Funding such structures is giving them a chance to recover and fully take advantage of what lies ahead. Private organisations in foreign countries already do fund such treatment centers. In France, the Maison de Solenn is funded by Jacques and Bernadette Chirac via the Fondation des Hôpitaux de Paris, and provides inpatient and outpatient care to anorexic girls. Why not transpose this model to the United States? Demand for such structures is high, and there is a lot of work lying ahead to change how eating disorders are taken into account in the united states, and who gets access to treatment.

What is happening in Arkansas? 

 

Arkansas is everywhere in the media these days. After more than a decade without having carried out any execution (the last person to be put to death was Eric Randall in 2005, 12 years after he had committed murder), the governor of the state, Asa Hutchinson, scheduled the execution of seven inmates. The executions are supposed to be carried out within a 11 days span, starting Monday, April 17. This tight schedule is due to one of the drugs used in lethal injections in Arkansas: midazolam. Arkansas’s supply of midazolam expires at the end of April. Arkansas has never carried out any execution using this drug, a powerful sedative administered to the prisoner to make sure the inmate does not feel pain during the process and is not conscious. However, midazolam is highly controversial, as inmates who have been given the drug during their execution seem to have clearly felt something, voicing it and agonizing for as long as 34 minutes in the case of Ronald Bert Smith, who was put to death in Alabama last December.

On Monday 17th, at 7pm, it appeared that « Arkansas ha[d] asked the U.S. Supreme Court to overrule the state’s high court and allow two executions to continue as scheduled Monday night», according to the Arkansas Democrat Gazette.

Over the past few days in fact, the issue has become harder to follow. Appeals are made on various grounds, some executions are stayed, others are not, courts block and others do not. So, what is happening in Arkansas? 

First of all, who is scheduled to be executed and for how long have these people been on death rows?

Seven convicts are scheduled to be executed between April 17 and April 27. They are seven males, and each was found guilty of murder. Bruce Earl Ward, scheduled to die on Monday 17, was sentenced to death in 1997. On Monday 17 was also scheduled the death of Don William Davis, who has been on death rows since 1991. Stacey Eugene Johnson, is scheduled to die on April 20 and was sentenced to death in 1997. On the same day is scheduled Ledelle Lee, sentenced in 1995. On April 24, Jack Harold Jones and Marcel W Williams are scheduled to be executed and they have been on death rows since 1996 and 1997 respectively. Lastly, Kenneth D Williams is scheduled for April 27, and was sentenced to death in 2000.

The seven convicts, with year of sentencing.

Originally, eight death sentenced were scheduled to be carried out. One of the inmates, Jason McGehee, was granted a stay of his April 27 execution earlier this month.

Wait. How did that work?

McGehee filled an appeal for clemency. In fact he is not the only one to have done so: five of the other convicts did the same. Clemency is the ability of the governor of a state to come back on the decision of a trial. A clemency application is reviewed by a parole board, and in Arkansas the board is composed of seven members, appointed by the Governor and confirmed by the Senate. The parole board formulates a recommendation to the Governor, about whether or not he should grant clemency to the convict, and the governor usually follows the recommendation – even if technically it is a non-binding advice.

Process of an application for clemency

In McGehee’s case, the parole board recommended Asa Hutchinson, to grant the prisoner clemency. Following the recommendation of the board, the federal Judge D. Price Marshall Jr, granted McGehee a stay of execution while waiting for the decision of the Governor, as the timeline is particularly tight in this precise case. Hutchinson should follow the parole board’s recommendation in the upcoming days, and McGehee’s sentence is likely to transform into life in prison without parole.

How come the convicts have been incarcerated for so long?

Each case is different. In fact, it is not unusual for a convict to spend several years, and even decades on death rows. In 2012, the average time between a death sentence and the execution of the sentence was of 190 months. The trend is clearly positive, as this average was only of 74 months in 1984.

Average time on death rows, in months (deathpenaltyinfo.org)

Why do prisoners spend so much time on death rows?

Once the final appeal is reached, the execution is scheduled and carried out rather fast. However, there is a gigantic amount of procedures between the sentencing, and the final appeal because multiple appeals can be made, under different names, following different procedures and filled at various courts.

To get a better understanding of the process, let’s see what happens when an inmate is sentenced to death in California by highlighting the main steps of the procedure.

Death penalty in California… and how long it takes for execution to be carried out (law.stackexchange.com)

The whole judicial development involves four different courts at different levels. One is the state Supreme Court. When the sentence is pronounced, the legal representation (that is to say the lawyer) of the condemned can fill for direct appeal in one of the state’s appeal court (and this already takes from 9 to 18 months). An appeal must be filled only on the grounds of what was recorded during the trial, that is to say either challenging some of the information, or arguing that judges made a « harmful error », getting in the way of a fair trial.

If the appeal is rejected, the state Supreme Court can be asked for review but does not have to consider the case. Only one direct appeal can be made.
Of course, the procedures do not end with direct appeal being rejected. There is an arsenal of legal instruments that the prisoner and his legal representation can use. One of these instruments is called a writ. A writ is supposed to be processed faster than an appeal, and is technically a document issued by a court granting a lower court the right to pursue legal actions in its name. Now in fact, it turns out that it is much more complicated than this in practice, but also clearer than this plain definition that comes straight out of a law dictionary.

In our case, the petitioner, that is to say the prisoner condemned to death, usually fills a writ to ask the right to appear in front of a court for his trial to be reviewed. The most well known writ is the writ of habeas corpus. This writ of habeas corpus challenges the legality of an incarceration, using as a ground the 14th amendment to the US Constitution, and pointing at what went wrong during the trial, or possible missing pieces of the case (the writ does not have to be filed on grounds explicitly present in the record of the trial, contrary to direct appeal). In other words, a writ of habeas corpus can be filled when it is likely that a prisoner has been denied constitutional right to a fair trial. As a reminder, section 1 of the 14th amendment states that: «  No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law ».

There is also the possibility to apply for writ of certiorari when the appeal has been denied, which means asking the Supreme Court to consider the case. However, the Supreme Court does not have to do so ( and it turns out that it considers less than 2% of the cases for which such a writ is filled every year).

How does a case get to the Circuit Court step on the California explanatory graph, and what is a Circuit Court? 

When an appeal has failed at the state level Court, one can apply to the next higher level court. So in our California case, this means turning to courts of the 9th circuit, one of the 13 Circuit Courts of the United States. A Circuit Court handles appeals at the federal level, and the courts are divided between geographical zones because the judges are mobile between the several courts of a same circuit. These courts are specifically made for appeal, that is to say that no trial happens at this level, and the Circuit Courts do not pronounce sentences. Usually, a Circuit Court takes a very long time to review a trial and issue a ruling.

The whole process of appeals can stop at this point, but appeals for clemency can be filled, as in McGehee’s case.

Summary of different levels of courts

What makes the cases in Arkansas so specific? 

In Arkansas, the pace of the scheduled executions is unprecedented since the reinstitution of the death penalty in the US in 1977. It has caused international uproar and indignation.

What makes the cases in Arkansas different is that there are many matters being discussed at various court levels at the moment. One of the issues that was argued at the Supreme Court of Arkansas this past few weeks had to do with the legality of the use of midazlolam, and whether or not it qualified as a « cruel and unusual punishment ». The Swiss firm Hoffman La Roche, that invented and produces the drug, was not even aware of the fact that its product was going to be used in capital executions, and decided to stop selling the drug to states altogether, although some states did try to curb the interdiction. However, challenges on the grounds of the legality of the drug fell short after the Supreme Court of Arkansas ruled that it was legal to use midazolam in executions.

Moreover, dozens of judges have sent a petition to Asa Hutchinson to request a stay of the executions. A Kickstarter was launched to fund the visits of the families to the inmates. Of course, the convicts are filling applications for clemency. The media and independent initiatives such as the Fair Punishment Project, funded by the Harvard Law School, are challenging the very validity of the trials.

Because there was something wrong with the trials?

In fact, it turns out that all the men scheduled to be executed in Arkansas have an IQ falling below 70, which qualifies for mental illness and impairment. Bruce Ward is a paranoid schizophrenic (he does not believe that he is going to die, but that he is leaving soon to go on a « special mission as an evangelist ». He also sees dogs all over his cell.

No independent party has ever assessed Don Davis’s mental health. It is all the same for Ledelle Lee. Stacey Johnson’s lawyer has never taken a closer look at his client’s personal background. All of the convicts suffered from constant neglect during their childhood. Their families beat them and they grew up in crushing poverty. Some of the men were raped multiple times, and Marcel William’s mother pimped him on a regular basis in exchange for food stamps and a place to stay. All of them have suffered from bad and inconstant representation during the course of their trial. The Fair Punishment Project argues:

« Across the eight cases, the quality of lawyering that we detected falls short of any reasonable standard of effectiveness—one lawyer was drunk in court, while another struggled with mental illness. Several of the lawyers missed deadlines, failed to visit their clients, and continued on a case despite the appearance of a conflict of interest. »

The Project suggest that the governor issues a moratorium while further investigation is conducted.

What happens next?

The Supreme Court is likely to review the cases and last minute appeals because of the uproar the affair is causing. So far, no execution has been carried out. Yesterday, the Supreme Court of Arkansas stopped the executions of Don Davis and Bruce Ward. However, the attorney general of Arkansas challenged the decision of this court and asked for the US Supreme Court to overrule the decision for Don Davis (remember, no background research of his mental health has been conducted, so he is not considered as mentally impaired contrary to Bruce Ward who is acknowledged as being, according to the Fair Punishment Project, « insane »). The Supreme Court did not overrule the decision: it suspended the execution of Don Davis. We are now waiting to see what will happen to the other inmates, and what the Supreme Court will rule when reviewing the inmates mental health condition. Much more is to come in the following days. Remember that no stay of execution has been issued for the other 5 convicts… yet.

How we tried to build a video tree

Instead of going out there to source YouTube videos and Twitter posts, we decided to create a new tool to source content that helps people better understand others in all parts of the world.

Before online news and social media (yes, there was a ‘before’—weird right?) people stayed updated by reading print copies of local or national newspapers. The newspapers had editors who curated material and aimed to show a diversity of content. Readers would stumble upon whatever news stories were included.

Now, readers are able to seek out news. News websites personalize news for the particular readers. Many readers say they ‘get their news’ through social media sites. Personalization and social media lead to often-discussed ‘echo chambers’ or ‘filter bubbles’, e.g. exposing people to repeated articles carrying political views that align with their own.

Attempts have been made to make people care about global news. News editors often want to include more global news, but need to meet the demands of the readers. They are confronted to very tangible barriers, as simple as the language barrier. Global Voices is a site for citizen media reporting from 167 countries, co-founded by Ethan Zuckerman that aims at overcoming the language obstacle by providing translations.

There’s another problem. We argue that we should pay attention to what is happening elsewhere in the world, and particularly in countries that are socioeconomically and culturally different from our own. We also think that it is only by reaching out to people who are different and by trying to understand conflicting points of view that we will be able to foster a news ecosystem within which people can mutually understand one another. Initiatives to increase communication between people holding different political opinions have recently taken place, for example in the state of Washington. A group from a highly Democrat county simply drove down to the most Republican county of the State to have a face to face conversation with the people who voted exactly opposite of what they did. (https://theevergrey.com/took-10-hour-road-trip-cross-political-divide-heres-happened/)

We believe that these face to face interactions are important to create empathy and a deeper understanding of issues. However, face to face interactions are not always possible, for geographical reasons for example. Or simply because sometimes our circles of friends are people who share similar views and daily experiences. How might we encourage people to reach out to others in a way that encourages asking questions and listening? How might we engage all parties, so that rather than passively reading news about an event at a distant location, people are reaching out to those locations and asking questions?

We propose a new kind of community—one where community members answer any question that someone else has asked previously, and then contribute by asking a new question. Responses are submitted as videos, because, as we just stated, videos are human and induce empathy. Over time, the sequence of videos constitutes a tree, spanning responses from all around the world. This is the tree of global connection.

What might a tree of global connection look like? Well, we went ahead and created a prototype.

http://manyshades.herokuapp.com/.

Landing page

Submitting a video 

 

Okay, so taking aside some of the fluff:  We have a thing that lets people submit YouTube links and then displays them on a website.

We had fun making the website (aside: we had quite a laugh when writing “gray” with a green font), but the website now does not communicate the vision that we have articulated in this blog post. These are some steps to improve the website to better meet its purpose:

  1. Certainly:  
    1. Instead of listing the videos one by one in a row, display the videos in a tree graph to show how questions and answers are connected.
    2. Determine a name, slogan, and symbol.
    3. Tag each video, enable browsing by tag, each tag having its own tree graph
    4. Miscellaneous:  Additional effort for users to upload video to YouTube; There’s no verification that users submit YouTube videos that they have personally uploaded; We’re currently using an MIT video for the banner; We’re using a heroku domain
  2. Maybe:  Implement geolocation and a map view, and show the trail of the question-answer “ball” being passed around touching different areas of the world.

Further, while we tried to post a link to the website on Reddit and, we need to gauge interest from a wider audience and engage with people who might potentially use this tool.

In the end, to more properly reconnect our project to the assignment, we think this tool could be used for people to ask questions about world events they cannot witness in person, and that they have trouble understanding. Through these short videos, users could create question chains on all issues going around the world and create a deeper understanding of news events that can tend to be stripped from personality.

The tree layout would enable users to have an overall view on each issue, and to quickly find answers to the questions they are asking themselves and respond to what they feel they can add knowledge to.

 

— Katrine and Marie.

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Décodex: on Classifying News Sources and Fact-Checking Fact-Checkers

On February 1st, the biggest daily newspaper in France, Le Monde, launched an initiative to combat fake news and biased information sources called « Décodex ». Or at least try to.

Décodex is made of several components. It consists in a search engine, Mozilla and Chrome add-ons, a Facebook Bot and pedagogical documentation on how to be a more careful online news reader. It catalogues 600 websites and classifies them according to their « reliability ». I put the term in quotation mark, as this reliability is assessed by the team building the tool, team called Les Décodeurs. Les Décodeurs is a branch of Le Monde specialized in data journalism and fact checking headed by Samuel Laurent.

Firefox add-on: -What does it mean? A barely reliable website propagating conspiracy theories. -Is this website reliable? This website regularly features fake news or misleading articles. Be careful and look other more reliable sources. If possible, look for the origin of the information.

The tool has a straightforward – yet arguably unattainable – ambition: verify if a website is, or not, reliable. It can be used by journalists, but also by anyone reading an article online. Its functioning is very simple, perhaps even too simplistic. You, curious yet naive reader (until now) surf the web, end up on a website, click on the Décodeurs extension that will give you one of the 5 following answers concerning the visited website’s credibility:

From Top to Bottom: [GREY] – Warning, this website is not a source, or its reliability is too variable to fit our criterias. To know more, look for other sources and the origin of the information. [BLUE] – Warning, this is a satirical website that is not made to propagate real information. It is a second degree read. [RED] – This website regularly propagates fake news or misleading articles. Beware and look for other more reliable sources of information. If possible, look for the origin of the information. [YELLOW] – This website can regularly be imprecise, not giving information about its sources and not conducting regular fact checking. If possible, search for the origin of the information. [GREEN] – This website is considered as reliable. Do not hesitate to confirm the information by looking for other reliable sources or the origin of the information.

The Facebook bot version leads to the following user experience:

In many instances, you will end up clicking on the link to the documentation, and learn how to find the original source of an information, and how to cross check what you are reading. If the website is not classified yet, you can also report it to the Décodex Team.

This documentation is, to me, the most innovative part of the tooI. I had never heard of any team in a newspaper sitting down to write proper guidelines to information search and evaluation. Perhaps because there are no definite guidelines, but I find the effort legitimate and fair in the current state of the industry, as social medias are blurring the line between fake and truth. At the heart of the Décodex initiative is the will to give the power back to the people and avoid the propagation of erroneous information. As they put it themselves, the tool represents « a first step towards mass checking information ». Hence, a democratization of the ability to identify what is reliable, and what is not. However, a first critique can already be made when looking at the Décodex classification. Websites categorized as « reliable » are mainly mainstream medias ( Le monde, NYT, CNN, etc…). Is it because you are an independent blogger that you are unreliable? Not necessarily, would I argue, but Décodex’s answer to this question is yes.

Additionally, the very existence of this tool triggers concerns. First of all, many websites, especially some that are considered as being on the right side of the political spectrum, have fired back at the initiative as some were classified by Décodex as « biased » newsources. Le Figaro rightfully asked the question « who will fact check the fact checkers? », and this is, I think, important: how can one claim, as Décodex seems to be doing, that she is completely unbiased, hence has the aptitude to judge others’ biases? How can one claim her classification of reliable sources is the « right one », that everyone should abide by? What prevents other sources to build the same tool, and classify the first classifier as non reliable in retaliation?
In some instances, however, the classification can hardly be argued. The Onion, for example, is classified as being parodic: everyone knows and acknowledges that The Onion is a satirist « news source ». The editors of the publication acknowledge it themselves and that is the very essence of their editorial line. The entire « not fully reliable category », is vague on purpose and encompasses platforms from breitbart.com to Russia Today. It seems hard to find generalized and cross cutting definitions of what makes a website enter this category.

Another important problem with this tool is the following: are the people who tend to share and read fake news going to use it? As a tool built by the mainstream media that is Le Monde, and the media undergoing an unprecedented credibility and trust crisis, is the initiative going to be considered as having enough credibility? Or is it going to be judged as biased and be a subject of an even more intense criticism? Is it going to be truste or not? Can it be relied on? A large amount of articles have been released criticizing the Décodex classification. Which brings in the big question: does Décodex even make a difference?

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Marie’s bio

Hi everyone!

My name is Marie Patino, and I’m an undergrad at MIT, more specifically an exchange student from France where I study at Sciences Po. Originally I am a social sciences / political sciences major which involves a bunch of reading and criticizing but rarely building anything, at least not at the undergrad level.
Which is also why I am here, as I would really like to take advantage of the class to learn how to build things. After a semester at MIT, I now know how to open a terminal. Well, maybe a little bit more.

Random interests: long feature journalism, radio ( not even podcasts, more like the radio in general), sociology, photography, writing, Swedish thrillers, Wes Anderson movies, Benedict vs OttersNicolas Cage memes and the ncage extension.

Also, I am interested in just learning and discovering everything outside my field – and inside it that I don’t know yet. I am very excited to be in class with you all, can’t wait to get to know you better, and work together.

You can follow me here: @mariepastora. Sometimes my feed is in French because our Presidential elections are being incredibly messy at the moment. Which means that I share a lot of articles about the candidates and complain about how corrupted some of them are.

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