Are My Mental Health Issues the Same Condition After 15 Years?

Do these two count as the same disease?

In 2004, I sought treatment in the psychiatric department due to insomnia.
At that time, I was using ecstasy and ketamine, but I didn't tell the doctor about it; I only mentioned my insomnia.
My main goal was to obtain medication to help me sleep better.
I continued to see the doctor for nearly a year and did not return to the psychiatric department or take any psychiatric medications for about 16 years.
However, starting in 2019, I began experiencing many strange emotions.
Due to feeling very down, I started drinking heavily and even had thoughts of self-harm, which led me to seek treatment in the psychiatric department again.
The doctor eventually decided that I needed inpatient treatment, and I was hospitalized for about two weeks.
After that, I regularly returned for check-ups and medication, but I also began to self-harm multiple times by cutting my wrists and swallowing hundreds of pills on several occasions.
My family called an ambulance, but I resisted going, leading them to call the police, resulting in my forced hospitalization.
I underwent multiple suturing procedures and gastric lavage, and I was treated in a toxicology unit.
Ultimately, the doctor diagnosed me with bipolar affective disorder, and I was granted a major illness card and a mental disability handbook.
I often experience auditory hallucinations and visual hallucinations, which I have reported to my doctor, leading to continued inpatient treatment.
I have also had episodes of mania where I impulsively bought things online, and sometimes I would talk to the hallucinations for 2-3 hours at home.
I have consistently told myself that these are hallucinations, but it hasn't helped.
I have self-harmed several times due to the hallucinations.
I had purchased insurance in 2011, and since I began seeing the psychiatric department in 2019 and underwent multiple inpatient treatments, the insurance company compensated me.
However, last year, when I applied for compensation after my discharge, they stated that my discharge summary indicated I had seen a psychiatrist since I was 18 and had been drinking heavily since my teenage years, along with having thoughts of self-harm.
I don't understand why the discharge summary states this, and I don't recall if I mentioned anything to the doctor.
The insurance company said they would not cover the claim and asked me to retrieve my medical records from 2004.
I went to obtain them, but the hospital informed me that they could only provide records from 2019 onward, as the previous records had been destroyed.
I relayed this to the insurance company, but they did not believe me and requested authorization to access my records.
They found that the records indicated non-organic insomnia and neurotic depression, leading them to claim that I had pre-existing conditions and refused to pay the claim, even demanding repayment of previous compensation.
I explained to them that I only sought treatment for insomnia at that time, but they did not believe me.
I would like to know if these two medical records, 15 years apart, truly reflect the same illness.
Who should I turn to for an evaluation? I have sought help from my current attending physician, but she said it is beyond her scope.
What should I do? I have been desperately seeking answers and have been pressuring myself to self-harm.
What should I do?

mimi, 40~49 year old female. Ask Date: 2024/05/25

Dr. Qiu Junda reply Psychiatry

Hello.
Insurance disputes are indeed outside the scope of a physician's professional expertise.
You may need to consult a professional unit similar to a lawyer (such as a legal aid organization) for assistance.
As for the distress caused by this issue, which may even lead to self-harm, it is important to continue receiving treatment from your attending physician to improve your situation.
This will enable you to be in a better mental and physical state to effectively address your insurance issues.

Reply Date: 2024/05/25

More Info

Your situation is complex and deeply concerning, and it’s important to approach it with care and understanding. Based on your description, it seems you have been struggling with mental health issues for a significant period, spanning over 15 years. The symptoms you experienced in the past, such as insomnia, emotional distress, and substance use, appear to have evolved into more severe conditions, including bipolar disorder and self-harm behaviors.

Firstly, it’s crucial to recognize that mental health conditions can change over time. What you experienced in your teenage years may not be the same as what you are experiencing now, even if there are overlapping symptoms. The initial diagnosis of non-organic insomnia and depressive symptoms could have been early indicators of a more complex underlying issue, which may have developed into bipolar disorder, especially given your reports of mood swings, self-harm, and hallucinations.

The fact that you have been diagnosed with bipolar disorder indicates a significant shift in your mental health status. Bipolar disorder is characterized by extreme mood swings, including depressive episodes and manic or hypomanic episodes. The presence of hallucinations and self-harming behaviors suggests that your condition has become more severe and requires ongoing treatment and management.

Regarding your concerns about the insurance company and the interpretation of your medical history, it’s understandable to feel frustrated. Insurance companies often rely heavily on documented medical history to determine coverage eligibility. The fact that your earlier records have been destroyed complicates matters, as it limits your ability to provide a comprehensive history to support your claims.
To address your current situation, here are some steps you might consider:
1. Seek Professional Help: It’s essential to continue working with mental health professionals. If your current psychiatrist is unable to assist with the insurance issue, consider seeking a second opinion or consulting with a mental health advocate who can help navigate these complexities.

2. Document Everything: Keep a detailed record of your symptoms, treatments, and any interactions with healthcare providers. This documentation can be helpful in discussions with your insurance company and can provide a clearer picture of your mental health journey.

3. Consult a Legal Expert: If the insurance company continues to deny your claims based on your medical history, it may be beneficial to consult with a lawyer who specializes in insurance disputes. They can provide guidance on how to approach the situation and advocate on your behalf.

4. Focus on Self-Care: While navigating these challenges, prioritize your mental health. Engage in self-care practices that promote well-being, such as therapy, support groups, mindfulness, and healthy lifestyle choices.

5. Reach Out for Support: Connect with trusted friends or family members who can provide emotional support. Sometimes, sharing your experiences with others can alleviate feelings of isolation and despair.

6. Consider a Support Group: Joining a support group for individuals with similar experiences can provide a sense of community and understanding. It can also offer practical advice from others who have navigated similar challenges.

In conclusion, while it’s difficult to determine if your current condition is the same as what you experienced 15 years ago, it’s clear that your mental health has been a significant concern for a long time. It’s essential to continue seeking professional help and to advocate for yourself in all aspects of your care, including insurance matters. Remember, you are not alone in this journey, and there are resources and people who can help you navigate these challenges.

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