Why doesn’t insurance cover all needed health care services?
The “expert mentoring services” discussed in my recent blog post - as an important or critical needed service in certain circumstances (link) - are usually paid for as an out of pocket expense and are not covered by conventional or commercial health insurance.
If you have a health care savings account, services sometimes are covered which may not be by other insurance providers. Presently, our health care and insurance-based coverage system is dysfunctional and lacking in many ways. Costs are excessive for insurance coverage provided - often with additional co-pays and disqualification clauses.
There is a positive movement towards a one-payer system, like Medicare for all, that will hopefully allow for a fairer and broader coverage of more of our population. It is yet to be seen whether new developing insurance programs will cover what is now considered optional or elective services.
“Expert mentoring” and guidance type of services are essential and critical when needed - either at the beginning or at any time during a health care encounter. If the advice or direction you get is working satisfactorily, and you are making the progress you expect, then continue with the guidance you are receiving. Good health care providers are trained to get a consultation from experts, or a more experienced person, when faced with a complex situation or where the provider has not had sufficient prior experience. If the provider makes a referral for consultation and it is considered a medical necessity, it may be covered by insurance.
Unfortunately, referrals or consultations often do not happen, and the person with the health problem suffers as a result. At this point, there is the option of paying for the needed help, mentoring or guidance, or finding ways to develop the self-education and the skills needed - to help resolve the problems or to improve on the current situation.
These terms, labels or descriptors have more in common than not.
All these terms imply a deeper, more comprehensive look at presenting issues or problems - whether simple or complex (link to a page on integrative medicine). The presenting symptoms or crisis are seen as an opportunity to evolve, learn, and restore health and wellbeing, or to improve on the current level of discomfort, pain or suffering. Presenting symptoms or complaints are generally seen as a sign of a person (body, mind, and spirit) attempting to resolve, restore, or heal an imbalance or dysfunction, or as a call for help and support.
The spiritual emergence work and programs in particular – The Center for Spiritual Emergence - supports the emergence and integration of a person’s essential spiritual nature as part of the path to wellness and wholeness.
Spiritual emergence is a natural opening and awakening that may occur when significant life difficulties or events arise. Some people will approach the challenge through an established faith tradition or systematic spiritual practices. While other individuals will become inspired and motivated by unexpected peak experiences that creates an opening for change and transformational work. The spiritual emergence experience allows an opportunity to embrace the natural connection to the larger healing and balanced state of being. This can bring lasting change to limiting, inflexible self-concepts (mind-ego) towards a more integrative, flexible, functional, enlightened and awakened self - the true and real basis of healing and restoration.
According to Christina and Stanislav Grof, M.D., "One of the most important implications... is the realization that many of the conditions, which are currently diagnosed as psychotic and indiscriminately treated by suppressive medication, are actually difficult stages of a radical personality transformation and spiritual opening. If they are correctly understood and supported, these psychospiritual crises can result in emotional and psychosomatic healing, remarkable psychological transformation, and consciousness evolution" (Grof & Grof, 1989, 1990).
http://www.centerforspiritualemergence.com/spiritual-emergenceemergency.html
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