Mental Health Care: Expensive even with insurance

If you’ve been reading this blog for a while, you know I suffer with a mishmash of mental illnesses. For those who don’t — my list of diagnosed errors of the brain includes major depression, bipolar (II) disorder, generalized anxiety, ADHD, social anxiety, narcissistic personality disorder, among other, non-diagnosed yet still symptomatic crazies. Despite wanting to get through life without help for years, I’ve been in and out of therapy. Also, due to these illnesses and disorders, I’ve been in and out of jobs – which makes spending a ton on mental health treatment not the wisest.

This year I thought I had the good fortune of health coverage that would actually cover a reasonable amount of my weekly psychotherapy sessions. It would still be expensive, mind you, but after hitting the $500 deductible (that’s less than a month of weekly sessions) my outpatient therapist would cost just 30% of her total billing rate. Except, it turns out, that’s not true at all. It would be impossible to know this in advance of submitting a claim based on the way the health insurance benefits are explained. Apparently only $77 is considered a reasonable cost for a therapist visit, and the other $53 per appointment doesn’t even count towards the deductible.

Luckily with my somewhat decent savings habits this is not the end of the world, but it is just frustrating in principle. I know the insurance companies want you seeing an in-network psychologist — but the reality is that in-network therapists are swarmed with patients and don’t have time to accept anyone new. The few who do have availability and accept insurance are often an hour’s drive away and are poorly equipped for their profession from a personality standpoint alone. When I found my therapist — who charges me $130 an hour at the low end of her “sliding scale” — I decided she was worth the cost. I mean, not that I’m exactly suicidal or anything, but given I had some fits of suicidal¬†ideation paired fittingly with severe depression, I thought it was best I see a therapist immediately versus waiting months to get one some booked-up psychologists calendar for an initial appointment that would fall in the middle of the day when I of course had to be at work. You know, back when I worked. (It was two weeks ago, but it still feels like a long time ago now, I guess, since I had been on vacation the two weeks prior to them firing the depressed shell of a person I had become, though I doubt they realized I was depressed, beyond failing to show up at work as early as my colleagues and get my work actually done I seem more lazy than chemically imbalanced. And to be fair to all sides, I’m probably both.)

Now that I’m unemployed, though, I feel like I need therapy more then ever, but I can’t bring myself to seeing my psychologist again, not for $130 a session, not when I’ve finally achieved hitting the big $500 deductible of my $77 per session deductible-counted payments, but when I know each session will still cost me $53 plus 70% of $77, and that’s only if I keep my insurance under COBRA which is $399 a month. I saw her once – the week I was fired – because I felt that’s the sort of thing I should do. I showed up late for my appointment because I did the thing I do with my anxiety where I play a game with time to see if I can wait as long as possible to get somewhere and still get there, not early or late, because more than anything I hate being early and having to seem awkward twiddling my thumbs in waiting areas for therapist offices or anywhere else I didn’t have a clear reason to be at that exact instance. So I was late and she wasn’t surprised. We talked a bit, the session went by quickly. She made a comment of how I looked much “lighter” (not physically, but spiritually) as she knows well how my job was causing me a great deal of stress without any sign of suddenly being my life’s passion. I knew she was right. But that didn’t change my sinking fear of how to put together all the pieces again and salvage what’s left of myself for the next part of this journey.

We talked about another session this month, before I knew that my therapy appointments post deductible would only be covered at 70% of $77 plus $53, or $106 per session if you do not want to do the math. I don’t think a mental health adviser could or should suggest that someone on unemployment who is going to make, after taxes, less than the cost of her rent, and with no new job in sight, should spend hundreds of dollars per month on talk therapy, especially when there seemed to be little more to talk about that they hadn’t already discussed over the last year and thousands of dollars worth of brain doctoring. Well, of course that’s not true, doctors of all sorts aren’t supposed to advise one over financial matters, their job is to make you healthy again. It’s just with mental health and money the two seem to be tied a bit more tightly together than say cancer and money. Of course the doctor is going to treat a cancer patient because the cancer patient will die without treatment (well, she may die with treatment too, but not quickly as quickly or definitively.) Mental health is different because in many cases the treatment is not a life-or-death matter. If it is a life-or-death matter it’s hard to say until it’s too late. And even a weekly talk therapy session cannot save the most depressed and committed from ending their lives. Thus it seems like for those of us not ready to jump off a bridge just yet, mental healthcare is a “nice to have,” not a “must have.”

Besides, for less than the cost of one session I have this blog’s domain and hosting space for an entire year, and a host of anonymous readers, kind commenters, one-time lurkers, and bitchy trolls who make me feel shitty about being too honest here. At some point I think there is much in this world that is therapeutic beyond the cushions of my therapist’s office couch. None of that is covered by insurance either. Yet acupuncture, the eastern medicine which — I’ve tried out for my hormonal disorder despite being suspicious of it actually doing anything — is covered at 100% with a $25 co-pay per session for both in-network and out-of-network doctors, at least on my current plan that ends this month. It seems if mental healthcare were more affordable and more available, perhaps we’d all be a bit better off.

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5 comments

  1. Abigail says:

    As someone who is also bipolar (2, so probably not as severe as yours), I can see your dilemma. Finding a good therapist can be difficult, and therapy can be integral,especially in tough times. That said, it sounds like it’s not viable. I would explain the math to you current therapist and ask if there’s someone she could recommend. Also, before you take up COBRA I’m hoping you check out the healthcare exchange. There’s gotta be a plan that’s cheaper than that. Hopefully, one with a decent mental health coverage. It sounds like yours sucks.

    Obviously, I don’t know your network therapist options, but I think you’re writing off network options too quickly. If some have long wait times, call more. (Easier said than done while depressed I know.) In the various networks I’ve used, it’s been pretty easy to find someone who could see me right away. Obviously, personal results will vary and there’s still the issue of connecting with the therapist. But I think it’s something you should explore if you can manage it.

    That said, if things get bad, call your therapist ASAP. Suicidal ideation is serious stuff. I mean, obviously, but you know what I mean. Debt is better than death or even hospitalization.

    Also, are you keeping up with someone about medication management? You’ll need to make sure everything’s at the right levels, or it’ll just be even harder to survive this. It took them years to diagnose me as bipolar, and once they put me on mood stabilizers, I was significantly better able to cope. I still have hard days, especially because I also have chronic fatigue. But yeah, just please make sure your meds are right before you make any more big decisions.

    As always, I’m writing a novel and sounding preacher than I want, but I do sympathize. And if you ever need to vent about mental health, please feel free to email me. I’ve dealt with mental health issues for years — some of it while barely or not able to work.

    All this with a Type A personality. It’s taken me years to stop beating myself up. Well, as much anyway. Point being, I’m always glad to lend an ear, and I do talk about mental and physical health a lot.

    Okay, end of novel.

    1. Joy ( User Karma: 0 ) says:

      Hi Abigal. Thanks for your comment. I also have Bipolar II (I try to clarify that as much as possible in my writing as I def don’t have Bipolar I.)

      I don’t feel comfortable explaining the math to my current therapist because ultimately I do have the money in savings and she needs to make a living too. I live in an area where there are plenty of wealthy people who need to see therapists, it’s just capitalism.

      The cheapest insurance I can get is $250 per month. I don’t qualify for the healthcare exchange because I’ve made too much already this year. I know, not a bad problem to have.

      I tried in-network therapists and I had to drive up to San Francisco (1.5 hours) for anyone who was available. None of the in-network doctors at evening appointments. I gave up on in-network. It doesn’t matter anymore now since I won’t have my same insurance.

      I don’t take medication. I was briefly on lithium for a study about bipolar II and that made me feel crazy. I maybe should be on antidepressants but that’s a whole other added cost that I don’t want to be spending right now. I believe for me anyway so much of it is diet and exercise.

      Thank you for your thoughts and offer to talk, it means a lot, even in anonymous blog land.

      1. Abigail says:

        Do *not* go on antidepressants, unless a very trusted doctor says it’s okay. I’ve been told by docs that it can actually worsen the symptoms.

        I was put on Lamictil and haven’t had any problems. Obviously, individuals have different reactions. But especially in this stressful a time, I really would consider trying other meds under the supervision of a doctor.

        I guess I get that it’s a comfort level thing. Frankly, I don’t care about savings. Unemployed is unemployed, and no amount of savings means you should do something that doesn’t sense for your own financial comfort level. Which I assume is an issue if you’re worrying about going back to that person at all.

        All of that said, clicking with your therapist is a biggie. And if your other choices are that bad, I guess you gotta do what works for you.

        Oh, and yeah diet/exercise is a big deal. Right now I’m exercising regularly, if shortly, and it does help. But it would never be a replacement for my meds. But as always depression is an individual thing. I guess in the end, it comes down to living vs surviving. Especially if you’re trying to land a job, which means the stress of interviews.

        Gah, preaching again. Okay, well I’ll try to pop on over here and be supportive. But I’m also incredibly forgetful so… yeah. Seriously, do email or tweet or whatever if you want.

  2. josh says:

    Do you find therapists sessions to be helpful and money well spent? Do you feel much better after your sessions? I’m a guy, but unfortunately do suffer from depression periodically even though from the outside I have a good life with happy family, good paying job, house, etc. I grew up outside of U.S, so seeing a stranger to discuss personal issue seems foreign to me. I hate speaking with friends and family about it because most just have the “suck it up” attitude. Good luck in finding a new job and hope you can overcome your internal demons.

    1. Joy ( User Karma: 0 ) says:

      I think it’s definitely worth it, especially if you’ve never gone before. But there are so many different types of therapists out there — not only by degree level (everything from psychiatrist who can prescribe drugs to a social worker who can also do individual therapy sessions) but also just personality and types of talk therapy they use. I’ve seen a number in my life and I find each have been helpful in some way, but some more helpful that others. I think there’s so much stigma around seeking help that most people don’t do it — even if costs aren’t an issue. I 100% think it’s worth it and esp if you know you are depressed. Not every session makes me “feel better” but overall the sessions help me reframe how I think about certain things, which is helpful in the long run. Usually you should plan on attending sessions for about 6 months minimum once you’ve found the right therapist, but I advise trying a few out if you can to find one who clicks.

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