Not Romantically Necessary: Reviewing Higher Level of Lovin' Criteria
My annual Valentine's Day attempt to have a romantic getaway, again, thwarted
It's become a Valentine's Day tradition on the frontier Psychiatrist to review the coverage criteria for romantic getaways, dinners with my wife, and other reviews of romantic coverage. Last year's unique articles on my Valentine’s Day plan demand that I try a biosimilar partner available here. Similar efforts were thwarted on Carlene’s birthday.
This year, I reviewed the criteria for a romantic getaway and learned, to my dismay,
and I do not meet the coverage criteria for such a special getaway.I'm sorry, honey, I tried, but it's not in keeping with our benefits.
Coverage Guidance
Coverage Indications, Limitations, and/or Romantic Necessity
Abstract:
A romantic getaway provides 24 hours of daily lovemaking in a structured, intensive, and secure setting for lovers who cannot safely and/or adequately make sweet, sweet love at a lower level of intimacy. This setting provides daily physician (MD/DO) supervision, should sildenafil be needed, 24-hour romantic gesture team evaluation and, although it's a little bit creepy, observation; couples massage services, and emotionally focused therapy as well as very thoughtful/heartfelt Hallmark-card interventions. Poetry supervision must also be available on a 24-hour basis in the case of heartache, misunderstandings, or emergent proposals.
Unforgettable romantic giveaways may be delivered in a fancy hotel, a well-appointed campsite under the stars, an Alpine chalet, a camp at Burning Man, or even a Michelin-starred restaurant, as long as there is an appropriately high-end hotel within the immediate vicinity. Psychedelic retreats and MDMA couple sessions are not included under this specific policy, and those levels of romantic connection are still considered experimental and unproven.
Indications:
Lovers admitted to a romantic getaway level of lovin’ must be under the care of a guru/couples therapist knowledgeable about the couple. The guru/couples therapist must certify/recertify (see Associated Information- Documentation Requirements section) the need for this very special romantic getaway. The lovers must require active gestures/attention to their most ardent desires. The lovers or legal guardians (in the case of those older adults with legal guardianship but for whom love is still very much in the air) must provide written informed consent for the romantic getaway in accordance with state law. If the lovers are into something kinky, like involuntary or court-ordered romantic activities, the services must still meet the requirements for romantic necessity in order to be covered by the plan.
Admission Criteria (Intensity of Service):
The lovers must require intensive, comprehensive, multimodal lovemaking, including 24 hours per day of romantic attention. Again, it may be off-putting, but direct supervision is necessary because of a need to feel deeply and passionately loved. The need for 24 hours of supervision may be due to the need for emotional safety and psychiatric co-occurring conditions. For those who may be “crazy in love,” potential severe side effects of erectile dysfunction medication associated with medical or psychiatric comorbidities or evaluation of behaviors consistent with being acutely head over heels for which a medical cause has not been ruled out.
The acute needs of the heart being evaluated or treated by the romantic getaway must require active attention, including a combination of services such as flower petals on the bed, bonbons, champagne, a selection of teas, a crackling fire in the room, gentle caresses, foot massage, access to a soaking tub suitable for two, or in the rare case is more, participants, room service, and access to the music that reminds the lovers of when they met. Lovers must require romantic getaway service services at levels of intensity and frequency exceeding what may be rendered in their daily life or even their favorite restaurant setting, including excellent restaurants like the one at which they had their engagement dinner. There must be evidence of failure at, inability to benefit from, or unacceptable risk in a romantic dinner or night out on the town setting. Claims for romance delivered at an inappropriate level of intensity will be denied. Couples are required to really work it, and if they're just phoning it in during a romantic getaway, it may lead to retroactive denial of the coverage. Seriously, don't bring your phones; these kinds of nights are supposed to be unforgettable, and you really shouldn't be checking your work email the whole time.
The following parameters are intended to describe the severity of needs of the heart and intensity of deep need for romance that characterize a couple appropriate for a very special romantic getaway. These criteria do not represent an all-inclusive list and are intended as guidelines.
Admission Criteria (Severity of Heartache):
Examples of getaway admission criteria include (but are not limited to):
1. Threat to relationship requiring 24-hour professional support:
Break up ideation or gesture within 72 hours prior to admission;
Accusations of an affair (actual or threatened) within 72 hours prior to admission;
chronic and continuing self-destructive behavior (e.g., ignoring one partner, not doing chores around the house, acting like we're just roommates) that poses a significant and/or immediate threat to life, limb, or the integrity of the relationship.
2. Threat to others requiring 24-hour professional observation:
assaultive behavior threatening people, whether actually or imagined, with whom a member of the couple has spent too much time or who there's gotta be something going on with, within 72 hours prior to admission
a significant verbal threat to the heart or status of feeling completely misunderstood within 72 hours prior to admission.
3. Not even wanting to listen to our song anymore.
4. Acute disordered/bizarre behavior or psychomotor agitation or retardation that interferes with the activities of daily loving (ADLs) such that the couple has difficulty getting it on.
5. Cognitive impairment (disorientation or memory loss) due to an acute threat to the relationship, in the form of that coworker with whom you felt a real connection, who is also having difficulty in their relationship, with whom one or both lovers are spending too much time.
6. For patients with demanding jobs, significant work stress leading to accusations that they are married to their job, putting their relationship in jeopardy.
7. A mental disorder causing major disability in social, interpersonal, occupational, and/or educational functioning that is leading to dangerous behavior as in regard to relationships, including but not limited to borderline personality disorder, bipolar disorder, narcissistic personality disorder, major depressive disorder, paraphilia, sexual sadism, sexual masochism, or other impairing conditions. Please note that conditions shared by the lovers (e.g., sub-syndromal, paired sexual sadism/sexual masochism), not generating interpersonal, occupational, or romantic impairment, do not satisfy this criterion.
8. A romantic disorder that causes an inability to maintain adequate sexual function or self-care, and community support cannot provide reliable, essential turn-ons so the lovers cannot function at a less intensive level of care during evaluation and lovemaking. Of note, young children in the home without appropriate grandparents satisfy this criterion, given other criteria are also satisfied.
9. Failure of outpatient romantic gestures so that the beneficiaries require 24-hour professional support and encouragement. Reasons for the failure of outpatient treatment could include:
increasing severity of stress at work;
noncompliance with suggestions by guru/couples therapist to really get in touch with each other thoughts, needs, and desires in the home or outpatient setting;
inadequate romantic response to visit to a museum and our Michelin star restaurant;
the inability of the patient to participate in a romantic getaway treatment because it's so hard to put away their phones and really focus on each other; things have just been demanding, you know, and it would just be so important to spend some time together, not being so distracted.
NOTE: For all romantic problem sets or issues, the severity and acuity of relationship challenges and the likelihood of response to treatment, combined with the requirement for an intensive, 24-hour level of get-away and really focusing on each other, are the significant factors in determining the necessity of a very special romantic getaway.
Discharge Criteria (Intensity of Service):
Lovers in very special romantic getaway settings may be discharged by stepping down to a less intensive level of loving in their regular lives. Stepping down to a less intensive level of service than a very special getaway would be considered when patients no longer require 24-hour care for safety, assisted romantic Jess, or active facilitation of gestures of love as described above. These lovers would become outpatients, receiving either one night a week of taking a tubby together or once every other week dinners/kinky stuff, if they're into that.
Discharge Criteria (Severity of Illness):
Lovers whose relationship condition improves or stabilizes, who no longer pose an impending threat to disability of their relationship, and who do not still require 24-hour care available in a very special getaway can be considered for discharge. Lovers who are persistently unwilling or unable to participate in active connection /lovemaking and refusing to really work on their relationship would also be appropriate for discharge, given romantically futile getaways or just torture, at some point you should probably just call it.
Limitations:
1. Failure to provide documentation to support the necessity of test(s) or treatment(s) may result in denial of claims or services. This includes medical records:
that do not support that the services are reasonable and necessary;
in which the documentation is illegible; or
where the romantic necessity for getaway services is not appropriately certified by the physician/guru/mentioned in a podcast by Esther Perell
2. The following services do not represent reasonable and medically necessary inpatient psychiatric services, and coverage is excluded:
services which are primarily social, recreational, or diversion activities, or custodial or respite care;
services attempting to maintain psychiatric wellness for the chronically mentally ill that are really all about you and your needs and not about us at all. God, you are such a narcissist sometimes.
treatment of chronic problems without acute exacerbation;
vocational training for those participating in sexual services/OnlyFans;
when supporting romantic records fail to document the required level of physician supervision and getaway planning process;
electrosleep therapy;
electrical aversion therapy for the treatment of pornography addiction;
hemodialysis for the treatment of sexual vampirism;
transcendental meditation;
Just phoning it in, even though it's in a really lovely setting;
Taking work calls the whole time;
Constantly being on your phone, despite how beautiful all of this is;
multiple electroconvulsive therapy (MECT).
3. It is not reasonable and romantically necessary to provide very special getaways to the following types of patients:
Lovers who require primarily social, custodial, recreational, or respite care;
Lovers whose heartbreak acuity requires less than 24 hours of supervised support per day;
Lovers who have met the criteria for discharge from Per Se, Eleven Madison Park, or other Michelin-stared restaurants;
Lovers whose symptoms are the result of a medical condition that requires a medical/surgical setting for appropriate treatment;
Lovers whose primary problem is a physical health problem without a concurrent major heartbreak episode;
Lovers with alcohol or substance abuse problems are really getting the way, and you need to address that first, honey, because if you don't get that stuff dealt with, it's gonna be really hard to feel connected to each other.
Lovers for whom admission to a romantic getaway is being used as an alternative to getting found out for cheating
Diddy, associates of Diddy, Drake, or anyone who is demonstrably “not like us”
4. Coverage criteria specified in this Local Coverage Determination (LCD) shall be applied to the entire medical record to determine medical necessity.
Summary of Evidence
N/A
Analysis of Evidence (Rationale for Determination)
N/A
"Not even willing to listen to our song." : )