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.