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Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Thursday, 15 December 2011

Why Swiss Health Insurance Doesn't always work (and why I now Love the NHS)

WARNING: If you get bored easily, you probably won't want to read this! Contains detailed workings of Swiss Health Insurance (yawn)

I had a fairly successful appointment with my Psychiatrist yesterday and one of the things we discussed was my health insurance.
I may have explained it before (and can't remember which blog post it was in) but it's like paying car insurance - you pay a premium and have an excess.  The smaller the excess, the higher the premium. When you have resided in Switzerland for more than three months you are obliged to have health insurance.
This is all well and good, when you pay your premiums.  When you see a doctor or other specialist or have a blood test, anything, the bill is sent to you and you then send a copy to the insurer who then refund you the amount of the bill less 10%.  You then pay the bill.  Sounds simple huh?
My problem was about two years ago I got into arrears with my premiums.  I tried making a payment plan with my health insurer, A. They refused and kept demanding the amount I owed which was 3 months worth of premiums for myself and my boyfriend at the time (he paid the rent).
As a result of the arrears, they then stopped paying my medical bills.  So as a result, any money I had had to pay the medical bills and not against the arrears.  I asked for a payment plan again.  They refused.
Well, I thought, I will change insurers so that the new insurer will pay my medical bills, close off my old insurance and make part payments until the arrears are paid off.
You can only "leave" an insurer twice a year, by the end of June or by the end of December.  To cancel the contract, the insurer has to receive your cancellation a month before the end of June/December and this has to be sent recorded delivery.  They are Swiss - don't follow thse rules and your request is ignored.
I duly sent the letter, correctly and within the timescale.  Insurer A replied with a letter confirming the cancellation.  I then signed up with a new insurer, O,  who sent me the contract which I signed and returned. I started paying the new insurer from the January.
Insurer A kept sending me bills.  I telephoned them and said they had accepted my "resignation" and I was no longer insured with them.  They said it was not possible to change insurer because I had arrears on my account.  I asked for a copyof the letter and they sent me the original "acceptance of resignation" PLUS another piece of paper attached (which they had not attached before) which stated that you cannot change insurance when you have arrears on your account.  News to me. I wrote to them explaining their mistake and they didn't accept it.  Meanwhile, the debt kept mounting up, but at least the new insurer was paying my medical bills.
So, to insurer 2, O. I explained to them that I was not allowed to change insurers because of the arrears and the new insurer said because I had now signed a contract with them, I had to continue to pay them insurance premiums. Problem: I was now expected to pay 2 insurance companies.
Of course, this put me in complete panic and being in a pretty poor mental state these days with coping with stuff like this I decided to refer to Social Services.  Initially I saw the SW as part of the Psychiatric service and she investigated, telephoned people, contacted Ombudsmen etc etc on my behalf and what she discoverd was interesting:

1. The Old insurer is meant to write to the proposed new insurer to "allow" me to leave them.  Insurer A DID NOT DO THIS.
2. You are not allowed to be insured by 2 companies.  Both insisted that I pay them premiums.
3. Basically, what these insurers were doing is illegal.

Anyway, to cut a long  and boring story short (thankfully, you say!), My medical bills and health insurance are now paid for by the state, the debt has mounted up and I have been placed on an official Swiss debt register.
I was discussing this with my Psychiatrist yesterday as he has been trying to get hold of my SW with no luck, so he is going to talk to the Psychiatric service SW to review this whole situation again.  If I have to have any seriously expesive treatment then there is some State "governer" type for health insurance who will approve the treatment.
This has been going on for 2 years now and neither insurer will accept any responsibility and I feel the pressure of it all.  Luckily my doctor will keep treating me, I can still see my Psych (although I have reduced the number of appointments) and my pharmacist will keep supplying me with medication as they all agree I need continued support and treatment.  This is where it is handy to have a more personal relationship with professionals (which somes with living in a small village) and they have been great.
But I don't half miss the NHS.  I will never complain about them again.  Well, until I am back into the system when I return to the UK.

Saturday, 12 November 2011

Psychiatrist Appointment Review

So I saw my lovely Psych last Monday and to be honest I thought I couldn't be bothered to talk and have been feeling grrreeeeeaaaatttttt! But when I got there I suddenly found myself becoming very articulate, clear thinking and demanding answers to questions in a much more forthright manner than usual (drugs or....?)
The Cipralex started working pretty quickly after he prescribed it to me at the end of September (10mg/day) and he seemed pleased with that, as am I and I explained about my clear thinking, positive mood, feeling HAPPY when I walked my friend's dog in the forest the other day (totally wierd and unexpected experience as I don't think I've had a flash of that since 2008) and that in general I am now fine and not mad. So he's upped it to 20mg/day in the morning to top up the Venlafaxine (now down to 150mg) with the Seroquel as a top up when needed (still every night to get me to sleep although I've had one night since getting back from the UK I had a normal night's sleep without it - yeay!) and the stash of other old medications at the back of my drugs drawer that he doesn't know I still have - never know when they might come in handy heh heh.
So, then onto the ECT debate.  Some of you have emailed me with some very sage advice which I am very grateful for.  I agree that in CH the psychiatric profession seem quite....well....keen to pursue this option in cases such as mine but I am still researching, researching, researching.  I explained to Dr I that at the moment there is no way I need it, but who knows what I will agree to when in the depths of despair and depression, so I would rather be informed as much as possible before that situation would arise and if necessary draw up a treatment agreement/non agreement stating what I would or would not consent to.  I asked when they give the treatment i.e. when I am feeling great and do it anyway, or when I am feeling shit.  He said they were able to guage how effective it was being if I started when I feel like shit.  He went through how many treatments there would be and that usually when I started it would be as an inpatient for two weeks to monitor me and then be treated as an outpatient until the "required" number of treatments had occured and then.....get this.....once a month "maintenance treatment"! When did that enter the plan? So, after a bit more discussion about how my family felt and the conflicting views of friends, plus my indecisiveness still as I am still confused by it all, I agreed to visit the Private Psych clinic where I was incarcerated 4 years ago around this time of year, for an appointment to discuss further.
However, whatever I decide, it is unlikely any treatment of such will be carried out in Switzerland for me.  I am planning on going back to the UK next April/May and start in Ski School in a couple of weeks and there is NO WAY I would be able to be admitted as an inpatient or attend outpatient treatments a couple of times a week over the winter AT ALL, unless I go a bit mad in the meantime (which is a possibility, who knows where my moods take me) in which case, as I mentioned earlier, I want to have a Crisis Treatment Plan in place that everyone understands what I have or haven't agreed to.  I need to look up the Swiss law anyway on being "sectioned" as I would imagine they are probably a bit more strict over here given their love of law and order.
Watch this space people.....I will let you know how that appointment goes and they had better be prepared because I will be demanding answers.

Monday, 18 July 2011

Health Insurance (again)

So I have come full circle.  The problem started with my health insurance 2 years ago when I fell behind with the premiums.  So I changed insurers as Insurer 1 stopped paying my medical bills until I had caught up with the arrears.  Insurer 2 were happy to pay my medical bills so I continued to pay the new insurer and get my medical bills paid.  I thought I had "resigned" the contract with insurer 1.  But no, I was not allowed to change insurers with arrears outstanding and they would not accept a payment plan from me although I offered this on at least 3 occasions. Insurer 1 should have informed insurer 2 that I could not proceed with a contract with them, but they didn't.
Insurer 2 then said because I had signed a contract with them also, that I had to pay them as well.  So in effect, I would have t pay 2 health insurers which there was no way I could afford. Insurer 1 kept billing me.  I kept telling them that I was no longer insured with them, so to stop billing me.  I saw the social services, but he misadvised me, so all the while insurer 1 kept registering my non payment as a debt.  I then had the government debt people chasing me for money which I didn't believe I owed and couldn't afford anyway.
Finally this year my psychiatrist referred me to the social worker based in the psychiatric department (no doubt he wanted paying too!) and she started getting involved.  Basically insurers 1 &2 were acting against the law.
Following so far?
Another three months down the line, insurer 2 started issuing refunds to me, although I had specifically said to pay back to insurer 1.  Of course, they weren't going to do this as that would show liability.  In the meantime I was referred to the normal social services department as my social worker had done all she could within her remit.
Hence I have now received another letter from insurer 1 repeating what I was told 2 years ago.  "We will not pay your medical bills untill all arrears have been paid".
In effect, this means I can no longer afford medication, I cannot afford to go to my GP, I cannot afford to go to my psychiatrist.  Normally after I have visitedeither of these /collected medication, I am billed.  This gets sent to the insurer, who then refunds me the total bill less 10%.  I can then pay the bill with a small contribution from myself so that it is paid in full.  I can negotiate part payment, but still have to pay my insurance premiums, so it is one or the other.
Basically, I'm screwed.  After half an hour of crying this afternoon I put my energies into sorting out exactly which bills were still outstanding.  I have an appointment with social services in the morning and they know that they have to deal with the insurance companies on my behalf as I am not mentally capable any more of communicating with them - it's too much and I don't always know the words to converse in German. 
I am also waiting for my unemployment benefit (3 months now) so I phoned them today.  They told me they still need more paperwork.  Would have been nice if they had written to me to let me know what was missing, so I photocopied every job related bit of paper from the last two years and sent it to them with a covering note to say if there was anything further missing all they have to do is look up my file from last October from when I last signed on and it will all be there.  Of course, being Swiss that probably won't be good enough and I will have to do the rounds of all my employers in the last 2 years to get copies of paperwork which the unemployment office ALREADY HAS!
Frustrated? YES. Upset? YES. Skint? YES (i have about five pounds to my name right now).
I know the meeting with social services will be awful tomorrow because I will get hysterical and cry because I can't take the pressure any more.  It's all too much.

Friday, 1 July 2011

Progress

I feel bad.  Very bad.
I've been feeling (up until now) pretty stable, not unhappy, able to cope.  However, a couple of things have been happening which I think have contributed to my mood suddenly skydiving.
First - ex boyfriend.  He split up because he said he wanted to be on his own.  Then he said a couple of weeks ago that he had never needed anybody (and although I don't want to feel needed, it's still hurtful that he doesn't need me in his life).  Now he is saying he is lonely.  Oh, and for some reason I still keep sleeping with him.
Second, I just found out that 3 and a half grands worth (CHF) of bills DID NOT get processed by the bank at the beginning of April.  And they didn't even send me a letter to tell me.  So I came back from holiday thinking the bills had been paid and oh look, I've done well managing my money and have enough to last me two months, which has now been spent on...well....living costs. So I am again behind with my psychiatrist bill and at the moment am in limbo between two health insurers so have no idea who is insuring me and who is paying my doctor's bills.
When I found out about the non-paid bills yesterday I really tried to not obsessively think about it.  I tried to do what that patronising prick Eckhart Tolle tells me in The Power of Now to just live in the situation. So I tried to distract myself but there was this little voice in the back of my thoughts repeating "FUUUUUCCCCKK" no matter what I did.  I disassociated from my feelings to try and cope.  Didn't work, the voice was still there. So I took some Seroquel to calm the voice down.  Promptly fell asleep for an hour which pissed me off as I haven't been sleeping properly at night for ages and didn't want to mess up my sort of routine.  (I was awake until at least 2 a.m. so yet more Seroquel to help me sleep).  Woke up this morning feeling generally low, lethargic and like I wanted to cry (and haven't been able to all day). Forced myself to get dressed and go out into the village (I needed some shopping and to pick up a prescription for Naltrexon) and found that I was feeling a bit disorientated and anxious about all the people.  Picked up my prescription and had a really nice chat with my pharmacist (she is a star and orders my drugs on emergency many times as I forget to reorder in time).  She asked me if I was living somewhere new as she had seen me carrying shopping at the other end of town.  I told her me and J split up in February, which she didn't know (her boyfriend was J's boss).  Anyway, she split up with her boyfriend (which I knew about) - he was 45, they had been together 20 years and he, like J, just turned round one day and said he didn't want to be in the relationship any more.  So there we were, in the middle of the pharmacy, bitching about men and mid-life crises.  But she said I looked better and although I felt like crying (which she kept apologising for) it was more because she was being so kind about it and not telling me crap like there are plenty of fish in the sea etc, etc.  She said we could meet up for a soft drink (she knows I have an alcohol problem) and that I can phone her any time.  We were both of the opinion that it can be a bit lonely sometimes and the thank goodness for our cat (mine)/dog (hers) to help us through.  Oh, and men are crap, pathetic little babies that can't deal with real life.  (Bit hypocritical on my part I guess).
Anyway, am at home now, a friend of mine will be on fb later to talk about not drinking (again) and hopefully remind me of the shame of alcohol.  I managed today all right but it is hard.  Still, am at home now and no alcohol in the house so as long as I stay in, I can get through today sober.
Doctor (GP) appointment on Wednesday, need to make another Psych appointment soon (when the bills are paid).  Still no job.

Saturday, 18 June 2011

Is there anybody out there?

I have felt pretty stable all this week, except for Friday when I was unusually tearful, lonely and frightened in my own home.  Maybe it's the extra Seroquel I am taking which is making me anxious or something?  I am on 200mg a night in order to sleep - I was on anything between 50-100mg but that stopped working and so I upped the dose.  I tried Wednesday night to sleep without medication but it didn't work and I spent the night in a permanent light sleep - so frustrating.
One thing I have enjoyed this week is reaching out and reading a lot of mental health blogs.  There seem to be some regulars and most are so articulate, way more so than me.  But what I have found is that I am not alone and some people have way worse problems than me - I almost feel ashamed to consider myself mental.  I know it is all relative and on my better days I will feel like I belong, but I have always had a problem of fitting in and I think sometimes I am thinking that I don't even fit into the mentalists world.  I have felt confident enough to post a few comments and hope I have worded them properly so that I haven't insulted anyone.
Psych appointment on Monday after my appointment with the unemployment office.  Am feeling a bit ranty towards my psychiatrist so it may not be an easy appointment.
Also, with my planned return to England I have been researching the kind of help and support that I can get.  I have found a support group in the area that I am moving to but the hunt for a psychiatrist to see privately until I am into the NHS system again, has not been so easy. I have also looked for psychologists but am totally confused with the therapy types (person centered etc.) so have no idea which one will be suitable for me.  It made me cry as it seemed so overwhelming and scary that I am going back when I am so used to a high level of support over here in Switzerland.

Tuesday, 9 June 2009

My experience of a Swiss psychiatric clinic (2)

The next morning, while walking to the station through the rain, my boyfriend and I formulated a story that I was going to England to update my Employment Law for my professional qualification in Human Resources – this was perfect because I would not be away for long and if I came back for the weekend it was a natural break between courses. . I purchased our tickets from the machine rather than going to the ticket desk – people knew me – they would surely notice I was buying a one way ticket to Meiringen and everyone knew what that meant.

J asked me how I was every 5 minutes. I just wanted to bawl my eyes out as I got more and more anxious – what was I doing? I had no clue as to who I was any more and the outside world became one big blur. The train journey was tense and I chain smoked at any opportunity. I felt confused, scared, numb, sad all at once and wished that the clinic was closer to home. With connections the journey took at best 1½ hours, at worst 2 hours even though it was only two valleys away as the crow flies. I was paranoid that everyone on the train could see me and my case and knew that I was mental. John was really calming and I felt guilty that he had to go through this experience. I remember that I kept apologising to him and he kept reassuring me – how draining that must have been for him.

We arrived at the destination station and although I had printed a map from the internet I couldn’t work out in which direction I should take to get to the clinic. So we called a taxi – I was so embarrassed that the taxi driver would know that I was being admitted, particularly when he dropped us off explaining that the entrance in front of us was for admissions. The drive wasn’t far to get there and to get to the admissions entrance, located in a large three storey building we passed the clinic tennis courts and the Funicular railway that takes you to the top of the Reichenbach Falls made famous by Sherlock Holmes. All was looking very high class.

I introduced myself to the receptionist (my boyfriend had joked that he looked more like the one who should be admitted) and we were asked to wait in the vestibule conservatory which looked out onto the gardens in front of the clinic. I was feeling very anxious by this stage and was nearly in tears – what was I doing?! I didn’t want to leave my boyfriend. We waited what seemed like an eternal five minutes for someone to arrive to take me to my home for the next week (or so I thought).

One thing I noticed about the clinic was that no-one looked like a nurse or doctor. In England it is very formal – suits and professionalism but in Switzerland I was likely to see my doctor in jeans. I didn’t mind this at all and felt comfortable as I think that suits create a formal barrier. Nurses both male and female at the clinic wore their own casual clothes and a name badge (which surprised me – think of the sharp pin on the back that some nutter could grab). My nurse for my admission was I think some kind of trainee, very pleasant and not great English but I managed to stumble through my German enough to be understood. She led us out of the building we were in across the forecourt and car park, past a restaurant (restaurant!) towards a two story building covered in overlapping blue/grey tiles which was open at one side of a square and overlooked a grass courtyard. Another building was attached to one corner of the square and this housed the thermal bath (wow – a spa!) and treatment rooms. I was led into a building labelled both old age care (I realised after a while that it was for geriatrics with mental health problems and not in fact anorexics) and emergency “acute” ward. The “akut” ward was the “closed ward” my doctor had spoke of.

This was to be my first experience of being locked up – all the carers, nurses and doctors had big bunches of keys and I came to spend many hours trying to figure out how I could get hold of a set without them knowing. Nora, my nurse assigned to me unlocked the door to the ward and led me and my boyfriend inside, closing and locking the door behind. We were led along a corridor with identical wide, white doors labelled with numbers or “Bad” (bathroom), “Besprechen” (meeting room) and suchlike. I was first led to a small medical room and asked to take my coat off. How humiliating – I was searched for sharp objects. I had kind of worked out that perhaps I wouldn’t be able to take my Gillette Venus razor “inside” and had to resort to hair removing cream (no way I was going to look like a gorilla when my boyfriend finally saw me again) but I was still shocked I was experiencing treatment like I was some kind of criminal in a police station, but I understood why they had to check – after all, there were a lot of nutters admitted who probably had whole knives on their person.

I was weighed (63 kilos – oooh, lost two since five months before without even trying), height measured, asked when I last had sex, bottom probed etc, etc, (Ok I am lying about the last two) and then we were taken to the “Besprechung” room where there was not one, but two other people, myself, my boyfriend and my new nurse. The doctor introduced himself (he looked so young how could he possibly be able to help me – I would give him a chance to prove himself though) as did another (male) nurse. They all sat there like it was an interview panel with pens and paper and a file in front of them. I didn’t like this. They asked me if I wanted to talk in German or English (English for this although I was embarrassed by it) and did I want my boyfriend present (No, because I hadn’t told him the full story and now was not the time or place). I was waiting for them to start taping the interview but they just took notes instead. John was released outside to smoke a packet of fags no doubt.

I began to talk. I cried. I stopped talking because I was too busy crying. Someone got me a fruit tea (one of many cups I was to drink in there), they interrogated me (every question to me in that state felt like a grilling) and finally they called my boyfriend back in the room. They asked him what I had been like. Now, my boyfriend is naturally suspicious of questions and of hospital like places, so I knew he wasn’t really going to lay it on thick. But he was as honest as he could be, the main worry for him was that he didn’t understand what was going on. It was surreal even to me, and I was the one who had agreed to go there.

The whole admission process took about two hours. Eventually I was shown to my allocated room for the night. It was a large, ground floor room with two “hospital” type beds in, overlooking a grass courtyard. To the other side of the courtyard were some outside tables and chairs where there was an old grey haired tramp (or so he looked) dressed in denim and smoking roll ups. The patio doors from my room to a small glass conservatory which led to this courtyard were locked. The other window next to my bed looking out was also locked. I started to feel oh so slightly claustrophobic.

While my boyfriend looked on, Nora let me unpack my few belongings and checked each item for more forbidden items. She took my mobile phone charger, iPod and charger and my purse. We were only allowed our mobile phones between 8 a.m. and 8 p.m., they would be charged in the nurse’s station. If we needed money we could ask for it again from the nurse’s station. She finally took my medication to be stored in a safe place, presumably to prevent me from taking an overdose. From now on, my tablets would be counted out and issued to me at strict timings throughout the day, usually with mealtimes.

The time came for me to say goodbye to my boyfriend, J. Poor guy, he looked more shell shocked than me and I knew he was twitching at even stepping foot in an institution, let alone the shock that his girlfriend was seriously ill. Still, I reassured him I would be out next week. As we passed the smoking room (yes, smoking is allowed in Switzerland) and I thanked my stars that I wasn’t in the UK where smoking was banned, I became less and less confident. My J was going home – I wasn’t. The doors were finally unlocked for J to go home and I gave him a hug. It was a bear hug like I will never forget and a lot of unspoken words were passed between us.

The door closed behind him. I knew he would come and visit at the weekend.


I returned to my room alone and sad. While I placed my belongings in some kind of order in the lockable cupboards provided, I reflected on the morning and the emotions that had been brought up. Here I was in near isolation, exhausted, weepy, knowing that I wanted to die but unable to explain why, wanting my boyfriend desperately, worrying that he was going to leave me like the last one had. I felt totally alone. As I put my wash things in the small bathroom I noticed that even the door didn’t have a lock and that everything was nailed or screwed down with no sharp edges or potential weapons of self harm.

I finally collapsed onto my bed huddled in a ball and wept, thinking all the time what a failure I was.

I couldn’t even do that alone. Every five minutes it seemed that my self pity was interrupted with questions about my medical insurance, was I OK, did I know it was lunchtime (I was most definitely NOT hungry) and that it was time to take my medication. Would I ever get any peace I wondered?

I ventured out of my room and along the corridor to the kitchen and dining area. All of a sudden, people kept introducing themselves, shaking hands and asking my name as the Swiss do. I knew they were trying to make me feel at ease but I just wanted to be left alone. When the meal wagon arrived (a large metal cabinet with rows of ready prepared trays) it was explained how to find the tray with my name and how to clear up afterwards.

I nibbled at my food and couldn’t wait to bolt back to my room, my semi safe haven. Occasionally I would glance sideways at the other patients. M would rock backwards and forwards in his chair, seated at a table well away from the rest of us. I couldn’t help but stare at him – couldn’t anyone see how funny he looked, rocking each time he ate a mouthful of food. He was clearly a bit mad. Then there was Frau X who stood back until everyone had collected their tray before she would take hers, nervously stepping in. T would scrounge everyone’s leftovers and being on the large side I wondered if she was meant to be eating them. I tried to avoid the men as they could have been sex attackers for all I knew. I felt bad for viewing the other patients in this way as after all, they were all lovely once I got over my initial suspicion and I was no different to any of them (except for Herr M, who one of the nurses put was “just a bit mad” when I complained about his constant screaming all day. We never saw him but the nurses would frequently check on him especially when it sounded like he would kick the door down. He was a definite candidate for plastic utensils and crockery. (We were allowed real knives and forks, except we had to ask for the bread to be cut with a breadknife which was then locked away again by a member of staff).

After lunch I again curled up into a ball and varied between sleeping and crying. I was so scared and confused. The nurses checked on me about ever half an hour, taking blood pressure checks and pulse checks, asking me if I was OK and finally a humiliating physical check by the doctor. Humiliating because I felt exposed and vulnerable despite the female nurse observing and I was worried the doctor would find something medically wrong with me. Finally I was left alone again.

The cleaners came in and washed the floor and bathroom. I lay curled up on the bed, disinterested. I crept under my duvet after they went and slept some more. I felt numb and confused but began to feel more comfortable in my little bubble.

Nora came in and took my insurance details (the all important medical insurance which would fund my stay at the clinic). She also checked what food I would like daily from a checklist. I could choose a continental breakfast or muesli, fruit juice or milk, a yogurt. I could be vegetarian if I liked. I selected bread and conserve for breakfast with a plain yogurt and a no fish dinner. We had menu plans given to us in advance for the week so we had some idea of what we were to eat.

It is usual in Switzerland for the main meal to be at lunchtime and to have a light supper. All our mealtimes were regimented – breakfast between 7.30 – 8.10 a.m., lunch between 11.30 - 12.10 and evening supper at 5.30 – 6.10. We received our medication from the medical staff at the same time. There were no extra snacks unless we shopped in town, which we had to ask permission for and were usually restricted to how long we could leave the unit for. To begin with I was allowed half an hour a day on my own, presumably so I didn’t have time to go and get plastered on alcohol. But at the beginning I had no intention of leaving my room, I was happy with my duvet and book. I read the three books that I had with me over and over again. Soon it was time for evening dinner, so I crept from my room and waited nervously by the lunch wagon. I wasn’t really hungry to be honest, but didn’t want the nurses to be hassling me to get up and go and eat. When my meal finally arrived on the meal wagon, I snatched it and sat in a corner.