“Hey, Steve, what are you up to today?” my coworker Danielle asked.
“Just applying for long-term disability insurance,” I replied. “Found out it’s really cheap. Not really sure why I didn’t apply for it a while back.”
“Well, good luck with that!” she replied.
“Thanks. I’m sure it’ll go fine. I mean I worry a little about my diagnosis but like, I’ve been as healthy as anyone for a number of years now. Don’t see why I wouldn’t qualify.”
“Yeah, you should definitely qualify. Talk later!”
“Okay, talk later!
I walked down the brightly lit hallways of the hospital, noticing the oppressive brightness of the fluorescent lights. “What do I have to do today? I know I have a busy day. Let me get this insurance application done quickly then I can do the things I need to.” I thought to myself. Unlocking the office door I quickly glanced at my name placard, “Steve Fedele, Certified Peer Specialist”. Shutting the door, I walked to my desk and logged into the computer. There were no windows in my office and we always joked that it was the least trauma informed office in the hospital. It used to be a closet but I loved how it didn’t have windows sometimes. I felt enclosed and safe within the office and it felt comforting to know that I was in a secure place.
I logged in to my benefits website and checked into the extended enrollment period for longterm disability insurance. I was forwarded to the outside provider’s website. “This is great I can get this coverage,” I thought to myself. “The extended eligibility period is great. I don’t have to wait til the end of the year.”
My back tensed up as I checked into the cost of the care. “Thank God,” I said out loud. I laughed a little bit as I read that it was about 76 cents per paycheck. “I’m such a cheap bastard,” I laughed to myself. “But I don’t have a lot of money. That’s not what I signed up for. This is great it’s so cheap.”
I clicked on the screen and the Proof of Health Form populated. “This should be easy,” I said aloud.
I scrolled through the questions and answered the first six as health conditions I didn’t carry. Scrolling to one of the last questions, I read it aloud.
The form read: Have you had or been treated for schizophrenia, a psychiatric hospitalization, or suicidality within the past five years?
I exhaled and felt the exhaustion I usually felt when things like this came up. “How should I answer this?” The ventilation turned off, leaving the room silent. My office was usually either oppressively hot or bottom of the ocean cold. We worked in an old building and the temperatures were difficult to regulate. “Technically, my diagnosis is schizoaffective disorder… I don’t have schizophrenia but it’s a schizophrenia type diagnosis. I guess I just want to be honest… I don’t wanna mess around. I’m an honest guy and plus if there’s ever a claim they’ll look for reasons to decline coverage.” I checked yes on this box. For all the other questions on the form I clicked no. Submitting the form, I waited for the results. My heart was pounding in my chest and I could feel the adrenaline making it’s way through the left side of my neck.
“DECLINED. Given the results of the eligibility form, we are not currently able to provide you with this insurance,” the screen read in bright red capital letters.
I sighed out loud, feeling incredibly exhausted. I hunched over in my chair and felt the air leave my lungs. “This sucks!” I said quietly. “Stigma everywhere… at work, at home, in the world, with everyone,” I thought quietly to myself. I could hear footsteps outside my door and the faint echo of voices through the wall. My emotions were suppressed and it felt like a boa constrictor was wrapped around my body. “Get yourself together, Steve. You have clients you’re seeing today. People are counting on you,” I thought to myself.
I got home that night, exhausted from another good day of work. I felt good about the effort I had put in, as I prided myself on effort every day. Snowflakes were steadily angling their way through the orange street light.
“Hey Mom, I was wondering if you had a minute or two?” I was on my cellphone. I put it on speakerphone and paced the condo as I usually did. She was always a good sounding board for things like this.
“Of course I do. I always have time to talk,” she replied.
“So they declined my longterm disability application,” I mentioned.
“They did?? How come?” she asked in exasperation.
“Oh you know. Same old shit,”I laughed out loud. I stood there quietly for several seconds. I wasn’t sure what to say or how to word it.
“What do you mean?”
My face flushed red and I felt another blanket of quietness wash over me. It felt like I had several fifty pound weights on top of my chest.
“Stephen, are you there?” she asked. A few seconds passed by. I just stared at the phone and stared back out the window at the falling snowflakes.
“Yeah, I’m here. It’s because of my diagnosis,” I finally muttered. I scuffed my feet a bit and a loud scruff sounded on the carpet. Dark grey tracks were left over the light grey carpet.
“Well, that sucks,” she said. “What if you get injured or something or you get sick.”
“I know, I know. I know it’s not right. What if I get sick or have other reasons that I can’t work like all the other reasons you can possibly need longterm disability insurance other than having schizophrenia,” I said.
“Yeah, that’s not right.” A few seconds paused as I waited for her to speak again. “So what are you going to do?”
“I don’t know what I can do. I’m definitely going to tell the director of the division.”
“There should be an appeals process. You should just file an appeal.”
“Yeah, that’s a good point,” I replied. “I mean I was employed at the butcher for four years and I was an assistant manager and I’m a supervisor at my current job for over four years. They definitely have to be reasonable.”
“I’m sure they will be. You’ve always been employed for the most part. It’s been twelve years since your last episode?”
“Fifteen,” I replied. “I haven’t had an inpatient stay for fifteen years. I’ve been working for the most part the whole time. Plus I’ve been a homeowner for six years. That has to count for something, even if I do just have a one-bedroom…”
“Of course it counts. And you have a nice condo, don’t get so down on yourself.”
“I know, I know. Okay, so I’ll file an appeal. This shouldn’t be too difficult.”
Two weeks later, I was on my usual morning walk through the hospital to my desk. Half the lights were on in an effort to save electricity over night and I was usually the first person to come in.
“Morning, Steve,” Danielle said as she caught up to me. “How is the appeals process going?”
I turned the lights to full capacity and they felt blinding. I squinted several times to adjust my eyes to the lighting. “I’m not quite sure. I sent our Division Director an email, and he was great. Super helpful. But the insurance company has been kind of a joke.”
“What do you mean?”
“Well, I emailed them to reach out about filing an appeal, and they mentioned it was something I could do but like didn’t actually give me any details about how the appeals process works or what I could do to help myself out. They never formally requested any paperwork or gave me any information on how it works. It’s been two weeks and I checked in to see if they needed any information and they still didn’t even reply. I’m honestly a little nervous they’re just going to make a decision without actually asking me for any information.”
“You look exhausted. This sounds really difficult.”
“Thanks. Yeah, I definitely am exhausted. I don’t know if I even care so much about getting the coverage as I do about just the stigma involved with all this.”
“Yeah, it’s pretty terrible. So what did the form say?” she asked
“They just screened for whether in the past five years I’ve had schizophrenia, a psychiatric hospitalization, or suicidality. It seems really random to me.”
“Yeah, it’s super random. There are a number of psychiatric diagnoses you can have that can make you unable to work.”
“I know. Seriously. They probably have some statistics they’re going off of or something but it seems pretty random. Some idiot just decided that schizophrenia was the thing we needed to watch out for… as usual.”
“Yeah, I’m sorry to hear you’re going through this. This is really difficult.”
“Thanks. Yeah, I just… I dunno. I dunno what to say to all these people all the time. I don’t know when society will change.” I sighed and stared blankly at a painting for several seconds. “I’m gonna go to my office and write an appeals letter.”
“Okay, well if you need anything let me know!”
“Thanks!”
I sat down in front of the computer and wrote the following letter to underwriting.
To Whom it May Concern,
Having had a diagnosis of schizophrenia for over 16 years, I feel like I should still qualify for long-term disability insurance. Currently I am a homeowner and have been so for six years, and I currently have a FICO Credit score of 826… In terms of employability, I have been employed full time for close to eight years, which started in August of 2014 where I worked at a Butchery. During my time here I started in the deli and worked my way up to an assistant manager of the store which was a position I held for over two years and just speaks to my work ethic and ability to excel in the workplace. In the four years I worked at this company, I never once used more than my allotted sick time and I never took a leave of absence for any health reasons and I took pride in never missing a day of work. While working here I made a career switch to work as a Peer Specialist at McLean Hospital, and during this career switch there were a few months where I split my time between both places until I fully transitioned to working at McLean Hospital full time. During this time period, I worked extra jobs and took on extra shifts to pay my bills and did not use any government benefits. At McLean Hospital, I coordinate a groups program which also provides supported employment and education for young adults 18-30 who have had psychosis. At this job I have never taken a leave of absence for my health and I have never used more than the allotted sick time in any year I have worked here.
Going back through my work history from August 2014 to May of 2010 when I graduated from UNH Durham with a Bachelor’s in English and a Minor in Business, I have not had a single period of over one month where I was not employed and bringing in a paycheck or otherwise in graduate school classes. During this time period I never used more than the allotted sick time for any of the jobs I worked and never took a leave of absence for mental health reasons at all.
I’m mentioning my employment history because having had a diagnosis of schizophrenia has not disabled me from working at all within the past twelve years. In fact, it’s motivated me to want to work more…
Thank you for taking the time to review my appeal.
Best Regards,
Steve Fedele
Several days later, I received an email from underwriting.
Stephen,
We have reviewed your appeals letter and we can not provide you longterm disability coverage.
Sincerely,
Clara
“So they didn’t give you any information on how to file an appeal?” Danielle asked. We were sipping coffee in the break room before punching in.
“Nope. Not a word. It was a fairly stoic letter they sent me to begin with. I had to check in with our Division Director who had to network through hospital HR, to the greater healthcare system, to a director, to get an underwriting phone number I could call to review the decision.”
“That sounds like a lot of work. Geeze, this is a really tough process.”
“Yeah, it definitely sucks. Plus I’m just lucky enough where I’m positioned well enough in my job and I know enough people where I can reach out for this info. I wouldn’t have a chance if I didn’t know half the people I know within the hospital.”
“There are rewards for being a good person,” she mentioned.
“Yeah, there definitely are. I don’t know if this is one of them. I’m gonna go call the insurance company.”
“Hi this is Michelle with underwriting.” The patter of the keys sounded in the background as she took notes. I shared my information and she brought up the account and the appeal on her computer.
“So we did receive your appeal, and it’s still declined.”
“What do you mean?” I asked. “How am I not an insurable candidate?”
“Well, we have a doctor on staff who reviews all the appeals, and the medical doctor declined your appeal.”
I laughed in disbelief. “So a medical doctor, who obviously has all the power and all the omniscience anyone in the world could ever had, denied the appeal,” I thought to myself.
“So it’s declined?” I asked
“Yes, that’s correct,” she stated.
“So you reviewed all the information I sent you, and you still can’t provide me longterm disability insurance?”
“Yes, that’s correct,” she stated.
“So, under what grounds are you not able to insure me? Did you read the letter I sent?”
“Yes, we did. The letter actually worked against you. You mentioned you had a psychiatric hospitalization and that’s another reason we can’t insure you.”
“The eligibility form states it had to be within five years. That was fifteen years ago.”
“We are sorry, sir,” she stated again.
“Okay, okay. So you know this is wrong right. Like, I work my tail off and I help as many people as I can every day and I work way more than a number of people who don’t have schizophrenia or any mental health conditions, and you’re still denying me coverage. What am I supposed to do if something happens? This is wrong. This is incredibly wrong.”
The pattering keys sounded in the background and the microphone on the other end rustled static. “It’s actually not wrong. Insurance law indicates that this is Voluntary coverage and not Mandatory, and by law this is a group plan. Being a group plan means that we can exclude for certain criteria.”
“I understand there are laws behind this, but what’s legal and what’s moral just aren’t the same.” I lightly dropped my shoulders and exhaled. “Are there any loopholes to this?”
“Well, if you had applied within the first thirty days of being employed we would not have to administer an eligibility form for coverage.”
“So you mean I would have gotten it if I qualified for benefits when first employed which most people almost never qualify for benefits when they are first employed.”
“That is correct,” she stated.
“So how do I file another appeal. This is ridiculous.”
“I’m sorry sir, but you can file more appeals but I don’t know if they will be helpful. We have already put the appeal through to the medical doctor on staff who reviews these cases.”
“Alright, well can I talk to the doctor? There has to be a mistake, I’m the most insurable human being on the face of the planet. Do you not want the money?”
“Sir, we unfortunately can not forward you to our doctor. No one is allowed to talk to the doctor.”
“Perfect. Just another barrier to care.”
—
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