My Ace In The Hole

I have excellent medical insurance and not-so-excellent mental health care insurance. For years, E. was in their preferred provider network, but she finally left them because they micromanaged treatment and reimbursed substantially below market rates. She left their network about two or three years ago. Now that she’s out-of-network, they don’t bother her much, and my co-pay increased from $10/session to $65/session. It’s a lot, but there’s no way I was going to go therapist hunting after years of working with her.

Suddenly, last week they called her to check in on me. I had triggered one of their alarms by having more than x number of sessions in the last three months, or something like that. They left her a message saying they wanted to know my diagnosis, my treatment plan, and what progress I was making. She told me this when I saw her last week, right before my surgery, and she said she’d talk to them. I felt a sudden fear that they we say I’d had far more than my fair share of therapy and would need to taper off. Or worse yet, go cold turkey.

In my session today, I ask what happened with the insurance. She says she talked to them yesterday for about 20 minutes. She explains they have a standard list of questions they ask. What is going on with her? Depression, E. tells them. (She always tries to give the minimal, least dramatic diagnosis she can and says the rest is not really their business and doesn’t need to be in my file.) How I am doing? Making great progress, E. assures them. Has she tried medication? (Ironically, they have no connection whatsoever to my psychiatric nurse, so they don’t know that I have been taking medication for years. With questionable results, I might add. Perhaps they should be sticking their nose into that side of things.) E. tells them I am on medication. Has she tried EMDR? No, but she has just started working with someone who might provide that for her.

Okay, fine, I can live with some insurance administrator writing all this down. It’s needless but whatever. The questions I care about are 1) are they going to check back in after 10 weeks or 20 sessions or something? and 2) do they want me to wrap it up within a given number of sessions?

No, E. tells me. “As long as you are making progress, they are okay. And since I am not in network, they don’t monitor my every move. They may not call again this year, for all I know.”

I know I look skeptical. I wait. She’s not the only one in the room who can use the pregnant pause to good effect.

“Okay,” she relents. “You know what is your ace in the hole? It’s the burning yourself. They are never going to cut you off when they hear about that. They want you in therapy.”

A piece of me laughs, on the inside. As long as I don’t give up the self-harm, they’ll never make me stop seeing her. Well, that makes it easy, doesn’t it? And what kind of backwards motivation is that for moving beyond the self-harm?

At the same time, I know E. could tell me this because she knows that as much as I value my time with her, I really do want to get better. One day, probably not in the immediate future, I will stop harming myself because I will stop feeling the need to do so. And someday further out in the future, I will start to reduce my visits to E. because I will feel confident that I can handle my mental health and continue to grow and develop without the intense needs I still have now. I actually believe this now. I didn’t use to believe that I could get better, but now I do, even though I have no idea whatsoever how long it will take.

(Until I reach that point though, I’ll keep an ace up my sleeve.)


  1. Talk about a sword of Damocles. Just reading this evoked so many emotions – how awful to be struck with the fear that somewhere, someone who has never met you might exercise the power to make decisions about your therapy. Like trauma isn’t disempowering enough. As twisted and ironic as the ace is, I’m glad that E gave you the power back by telling you about it.


  2. Ah this is crappy. It’s so frustrating that good mental health care is so expensive, and that we are then controlled and monitored and stigmatised for trying to access that care. Well, I’m glad E is protecting you and that you are indeed making progress. Take care.


  3. Her term “ace in the hole” sort of made me laugh. I hope that doesn’t offend you. And the ludicrous idea that you are qualified for treatment because you burn yourself, and when you stop, you might not qualify – that is just maddening. It really agitates me, actually. On behalf of you.
    I remember when I was inpatient at eating disorder rehab, one woman was “kicked out” half-way through because she stopped reporting feeling suicidal. Still raging eating disorder and very malnourished, but no longer reporting suicide made her ineligible. And of course I imagine when she went home, she went right back to feeling suicidal. This reminds me of your situation.
    I’m sorry you have the stress of worrying about coverage, and I am also glad E is there to advocate for you.


  4. I like that E didn’t tell them all your stuff. I’m glad you can see the progress you are making and that you not only want to get better, but know you can. Thank you for sharing your journey on here. Sending you some healing thoughts.


  5. Stupid insurance companies. I get so annoyed with them. I’m glad E told you about the ace in the hole. I think that would make me feel safe, knowing there was something to keep them allowing me to go to therapy. It’s so scary to think someone from a company that doesn’t even know you may have control over what is happening in your life and if you get therapeutic help or not. That’s just crap. I hope that the insurance is done with questions for the year. Xx


  6. Dear Q: I have Parts inside who all of a sudden feel burning. Especially at night. They are remembering things that happened. I am very upset that you burn yourself. I and my Parts are sending you cooling soft breaths. TS

    Liked by 1 person

    • TS, please don’t be upset. I am okay. I have burned myself a few times recently but it’s not something I do a lot anymore.

      What about you, are you taking good care of the parts who feel sudden burning? Can you make them safe? Sending you (and all the parts) warm hugs, Q.

      Liked by 1 person

  7. Isn’t that just crazy though? Hey, you’re self harming, so uh, ok. Keep going to therapy. But that’s just super annoying to hear because you’re just like another number to them. There’s so little empathy in this business, it makes me sick.

    I’m just glad that you won’t get cut off at least. And Q, your words resonated with me. You and I are on the same boat right now. I realize now that the teen is using the self harm as a means to keep us in therapy because she wants S to know she needs to be taken seriously – not that S has even shown that he hasn’t that is. But like you, I feel like someday, I might be able to overcome this and not feel like I need to do it anymore. And that I can depend on S less as well. For me, when I’m done with school, my therapy will end. That’s in many 2-3 years from now. In which case, I hope that I’ll be better enough to not need S anymore. Otherwise, I’m not gonna know what to do without him.


  8. wow, this is mindblowing, but so glad E felt able to tell you, bet you were glad she did too, cant really rap my head around their thinking though. But happy your therapy wont be stopped any time soon. XX


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