Yesterday I was informed that I was not approved to see my therapist through my insurance. I have Aetna HMO and my therapist is a provider with Aetna, however the plan that my employer offers contracts mental health services out to a third party vendor. My therapist is not covered by that third party. I was offered the option to request an exception, which I did. My therapist and I filled out paperwork and were readily available for the several phone calls to answer questions. Was I suicidal? No. Did I have plans to harm anyone or myself? No. Well, then they just cannot allow me to see my therapist. As a nurse I know that continuity of care is important, and the third party representative agreed, but she stated that there were other therapists in my network that could offer the same services. I explained that finding a therapist that I was comfortable with had already taken over a year of my time. I had already established a relationship with her; she helped me through a difficult time, got me back to work, and gave me valuable self-care tools. The third party person said she understood, but assured me that the list of strangers she had were just as qualified and covered by my plan. I did a quick google search for the list she provided me and discovered that the first suggested therapist has a one star rating and reviews stated hits like, “no compassion,” and “was worried about the insurance paying her on time.” I looked at the second who specializes in couples counseling and family therapy and realized this was not worth the effort.
This actually was not supposed to be the point of this piece though. This was going to be about nurse fatigue and burnout, specifically in oncology nurses. Burnout is a term coined by psychologist Herbert Freudenberger to describe the physical exhaustion that went with the stress of working in the healthcare field. This term has since been updated to compassion fatigue in reference to oncology nurses. Instead, I have to continue my story, because maybe that will shed some light on this serious problem.
In 2017 I was working as an outpatient oncology research nurse. My patients were primarily end-stage lung cancer patients. I have worked in oncology for five years – both inpatient and outpatient. As a research nurse I have worked on lung and breast cancer, melanoma, and now lymphoma clinical trials. The stress of the job was usually manageable, but the exhaustion of the navigating the bureaucracy of the healthcare system in hopes of providing the best care for my patients was overwhelming. I think the fact that a lot of the job included being in a constant state of unresolved grief is what eventually broke me.
My anxiety and stress were so thick that it was a rare occurrence to not end up sobbing uncontrollably either at my desk or hidden in a bathroom. During one of these episodes, I saw my primary care doctor and he wrote me out on medical leave immediately. He gave me antianxiety medication, offered antidepressants, and told me that I needed to see a therapist. I had been seeing someone off and on, but he was not going to be beneficial to me at that time, so I searched and found someone that specialized in everything that I needed: anxiety, depression, and eating disorders (cool bonus: I binge eat when I am sad or stressed). I started seeing her twice a week and she provided me tools to help with the anxiety, workbooks for me to complete to identify my triggers, and offered me alternatives to binge eating through the depression. During my medical leave, I discovered that the university where I worked used my money to pay for disability insurance and I did not pay into SSDI. I discovered this when California notified me that while I would have been approved per my doctor’s request, I was not eligible because we did not pay into the state funds. I had to go back to my employer and get the information to file a claim with Liberty Mutual. I was on leave for just under eight weeks and the claim was denied. The reasoning provided was that my therapist’s notes said I was able to maintain my GPA in an online college program so they determined that I must be able to go to my job. This was a financially difficult scenario, but luckily I am white and my friends and family were able to help me out.
I was able to heal and recuperate enough to realize that I needed a change of scenery. I got a new job at a new cancer center and that meant new insurance. My doctor recently asked how I was doing because I have been requesting refills on my antianxiety meds. It has been five months since I saw my therapist.
I am not only a provider of healthcare, but someone that needs it. The data shows that as an oncology nurse I am susceptible to backache, excessive nervousness, feelings of continuous stress, and unresolved grief. And yet, even with the endlessly researched data, I have been shown that the healthcare industry does not care. The disability insurance that I paid for refused to help me continue treatment and self-care so that I could go back into the work force. And the insurance that I pay for does not understand the necessity of an established relationship with a trusted therapist.
So while I beg our healthcare system to do better, I will continue to cry into my pasta and ice cream.
*image credit: AMSA.org