Memphis family case highlights Tennessee BlueCross challenges

The suicidal teenager has named her new baby ‘Clarabelle’.

Meredith Oest, 16, cares for Clarabelle three times a day, feeds, cleans up after and plays with the calf as part of her treatment program at Discovery Ranch for Girls, a 66-acre campus with 24-hour supervision on 24 for teenagers. Rural Route 130 in Cedar City, Utah.

Connecting with the animal seems to be one of the few things in her life that soothes Meredith’s troubled spirit. After a neuropsychological examination at the age of 15, Meredith was diagnosed with oppositional defiant disorder, depression, anxiety and maladaptive personality traits.

So far, she’s thriving on the Utah farm, a life passed without worrying about strained family relationships, school difficulties and police incidents in Cordoba, which is about 1,500 miles from Discovery Ranch. and about 20 miles from Memphis.

The bucolic treatment, however, is coming to an end.

BlueCross BlueShield of Tennessee, the Oest family’s insurance company, refused to pay about $15,000 a month for Meredith’s stay at the Discovery Ranch – even though they approved much more expensive treatment in Meredith’s past .

This week, the teenager is due to return to live with her mother and grandmother in Córdoba, where so many of her past troubles occurred.

“I fear she will end up injured, in jail or dead,” said Melanie Oest, Meredith’s mother. “When she’s home, it’s chaotic. Exhausting. I jump from fire to fire.

“It’s frightening.”

For most of 2022, single mother Melanie Oest battled with BlueCross, appealing for insurance coverage for her daughter.

Mélanie Oest is not the only one to complain about an insurance company.

According to statistics provided by the National Association of Insurance Commissioners, BlueCross BlueShield of Tennessee was the subject of complaints 42 times from 2019 to 2021. There is no data available showing the outcome of these cases.

In 2021, the Tennessee Department of Commerce and Insurance, which has jurisdiction over all policies written in Tennessee, negotiated 2,929 claims against insurers, resulting in the reimbursement of $8.2 million to consumers including the claims had previously been denied.

BlueCross BlueShield of Tennessee’s director of corporate communications, John Hawbaker, said Meredith’s case is “still pending as we work to obtain medical records from Discovery Ranch and the in-network treatment center that treated her. served before Discovery Ranch”.

In a detailed response expressing empathy for the Oest family, Hawbaker said the company understands the value of mental health care and is working to ensure “our members have access to proven treatments.”

“We have a comprehensive network of behavioral healthcare providers across the spectrum of care, offering everything from telehealth therapy to inpatient services,” he said.

But Hawbaker said coverage is only provided to network providers.

“Our Affordable Care Act (ACA) Marketplace plans — like those of all other carriers serving Tennesseans — only offer benefits for services provided by in-network providers,” Hawbaker said. “This is true for mental and physical health care services.”

Full statement: Read the full statement from BlueCross BlueShield at the end of this story

Still, by the time a final decision is made, Meredith is expected to leave the Discovery Ranch program.

Oest’s complaint argues that even though Discovery Ranch is not offered in the BlueCross network, Tennessee’s largest health benefit plan should cover it because it is medically necessary.

She sought help from the Mental Health and Autism Insurance Project, a California-based nonprofit that specializes in cases where insurance companies might overlook mentally compromised customers.

“Meredith needs more sophisticated care than they have in their network,” said Karen Fessel, the founder of MHAIP. “They’re not supposed to deny coverage if they have an inadequate network.”

Oest and Fessel filed a complaint with the Tennessee Department of Commerce and Insurance. They are still waiting to know the results.

“It’s a shame you can’t rely on the health plan to do the right thing,” Fessel said.

No matter who gets involved, BlueCross’ response has always been the same.

No.

“For her, life was an adventure”

Meredith Oest was a big personality, always loud, always happy to catch everyone’s attention in the room.

“She was so friendly,” Oest said. “For her, life was an adventure. She feared nothing.”

Oest said she thinks her daughter might have a future in acting.

Then, when she was about 10 years old, there was an incident at the church. Each of the parents had sent their children to Sunday school with bags of colored pens. A kid said Meredith stole some of her pens. When Meredith was confronted with a bag full of more pens than she had brought, Meredith insisted that was what her mother had given her.

Even if she had been caught, Meredith wouldn’t give up the lie. So Melanie drove her to the store to prove that only a certain number of pens went into a bag.

Finally confronted with the truth, Meredith said, “I must have misunderstood.”

“It’s her favorite line when she’s in trouble,” Oest said.

There were more incidents of small items being stolen from friends, but Oest simply chalked it up to childhood oddities.

When she was in 7th grade, Meredith came home from Briarcrest Christian School and announced, “You’re going to get a call. I was sexually assaulted in the bathroom.”

She said a girl pushed her against a wall and kissed her.

The school investigated and found that Meredith, whom she later admitted, had made up the story. The school was going to punish Meredith for lying, but Oest transferred her to avoid an even bigger scandal.

By 8th grade, Meredith’s problems were increasing.

A classmate’s mother knocked on Melanie’s front door and claimed Meredith stole her son’s watch. She had taken pictures of the watch and mocked the boy by posting pictures of the watch online.

The incident, however, did not end there. Oest said Meredith, who was 13, had a secret online relationship with an 18-year-old man. Oest said Meredith told the man that the boy with the watch hit her and convinced the man to threaten the boy.

The boy’s mother called the police, who came to her home. What happened next shocked Oest to the core.

“I’ve never seen such absolute disrespect,” Oest said of Meredith’s behavior. “Who was that kid disrespecting the police?

“I was completely floored by this number”

Just before her 14th birthday, Meredith was placed in a six-day program at the Daybreak Treatment Center in Germantown.

Over the next two years, she would be placed in different treatment facilities 13 times, including Newport Academy in Newport Beach, California. Most of these placements were full-time residential, meaning Meredith moved in full-time.

BlueCross covered all of these placements, none of which were satisfactory as a long-term solution for Meredith. At Newport Academy, she stayed twice, once between October 11 and November 27, 2020, and once between September 10 and December 10, 2021. The cost for Newport Academy is $13,500 per week.

“I was completely floored by that number,” Oest said. “But they paid.”

The total cost paid by BlueCross for Meredith’s treatment was $111,680.41 in 2020 and $242,467.64 in 2021.

Hawbaker said the numbers were a bit lower.

“We covered these treatments, which totaled 197 claims and $298,110.44 paid by BCBST since January 2, 2020,” he said. “Our records indicate that our care management team has also reached out more than 7 times since December 2021 to offer additional support.”

Between these residential placements, she would live at home. It was then that Oest noticed Meredith scratching her skin with paperclips and thumbtacks. She threatened to kill herself twice. Her behavior was so unstable that Oest said “our family therapist was afraid of her”.

Also while living at home, Meredith called the police twice claiming, falsely, that her mother and grandmother had abused her. In the middle of a grocery store, she called her grandmother the word c.

His second trip to Newport Academy, starting September 10, 2021, turned out to be a disaster.

She claimed she was sexually assaulted by a boy in Tennessee. The Department of Children’s Services investigated and found that Meredith was not telling the truth. She insisted she was pregnant, which she wasn’t.

Oest said she was told the investigations and misrepresentations hurt the person she accused and she said, “He’s a jerk, and he deserved it.”

“False accusations are his way of getting revenge,” Oest said.

Also in Newport, Meredith threatened to kill herself and was seen as a danger to herself. She was placed on “waiting 5150” for 72 hours in a psychiatric hospital.

When it was determined that she was not progressing in Newport Beach, Oest began looking for a long-term residential treatment facility.

“Trying to keep my child alive”

Oest chose Discovery Ranch for Girls in Utah for two reasons: first, it was a long-term program for all girls (residencies there typically last over a year), and second, it had the animal program, in which Meredith could work. with a baby calf to learn responsibility and empathy.

The cost would be around $180,000 for one year, which is significantly less than the $242,000 BlueCross paid for Meredith’s treatment in 2021.

“It was perfect,” Oest said.

But there was a problem. BlueCross recommended three other locations: Rogers Memorial Hospital in Wisconsin, The Villages in Tennessee, and Hillside in Georgia. Oest and Meredith’s treatment team determined that none of these locations were the right choice. Either they weren’t long-term residences, or they didn’t deal with maladaptive behavior, or they had a waiting list to get in.

Oest said she believed that since these were not correct, BlueCross would pay for the program that was correct.

There was an initial discussion with the insurance company on how to proceed. As Meredith’s future was under discussion, Oest secured two bank loans worth $70,000 and raised another $9,000 on a GoFundMe page. She sent her daughter to Utah hoping that BlueCross would eventually pay for her entire stay.

“I tapped into every resource imaginable,” Oest said.

BlueCross, again, said no.

Now, Oest faces the prospect of Meredith returning on June 1.

And she is afraid.

“I will try to spend every day trying to keep my child alive,” she said. “It’s a miserable way to live for both of us.”

Contact Keith Sharon at 615-406-1594 or [email protected] or on Twitter @KeithSharonTN.

Isabel M. Bourgeois