My route to work, apparently, is very treacherous if you are a raccoon. I see the remains of countless deaths each week, of all ages and sizes. I’ve become desensitized to the mass killings. You’d think the raccoons would just change their route, already.
Have you been on hold with Aetna lately? I have a few questions, first of them being do they want me to kill myself now?
I’ve concluded, after several hours on hold and in “conversations” with various call centers that there is no more stressful experience than trying to get what you need from an insurance company. They begin by playing the first phrases of Fur Elise in obvious repetition until, just before you begin smashing your head against your desk, they cut in to help you. Only literally no one at Aetna is a native English speaker and despite the clarity of the things I say they seem to never understand me. It’s a little like talking to a wall.
But that’s really not the worst part. The worst part is the coverage itself. I have what is considered “good” insurance and for most things it is satisfying. I can go to the doctor for twenty dollars and the specialist for forty. Most of my appointments fall under the specialist category but I consider it better than having to pay full price. However when it comes to what insurance companies call “Behavioral Health” getting the help you need is seriously off the mark.
Recently I’ve returned to therapy. It was a long hiatus, mostly fueled by lack of wanting to jump back into the psychologist “dating pool”. Finding a therapist that I actually liked that took my insurance was not easy. I have been to several since I moved here that were less than stellar and so I just stopped going. I need it though so, reluctantly, I opened up my provider list and started the search anew.
I have been fortunate this time to find not one, but two people who I think will be able to help me. One is a cognitive therapist and the other someone who will help me with relaxation techniques and give me some biofeedback. I am looking forward to working with the both of them to put some new tools in my not-being-crazy-toolbox.
First, though, I have to get past my insurance. As it turns out I am allotted only twenty behavioral health visits per year, of which six have already been used. I did the math: Until the end of the year that leaves me with fourteen visits that I have to split between three therapists (don’t forget I see a psychiatrist as well). Now, if I were coded as having a “serious mental health issue” I would have a whole sixty visits per calendar year, but most therapists hesitate to code you that way because it's harder to get life insurance blah blah blah.
This year I can probably finagle things to maximize my fourteen remaining visits, but what am I supposed to do for next year? Even if I was coded as having a “serious mental health issue” I figured out that sixty visits allots for general therapy every other week and a psychiatrist once a month. You can mix that up a little bit but it still doesn’t amount to much. If a person did, indeed have a serious mental health issue – like bipolar or schizophrenia – they would most likely need therapy once a week, and then hopefully they are only seeing their psychiatrist every three months, and that could work but here’s hoping they don’t have a break down anywhere in that time. Don’t change your meds, don’t have a crisis, don’t need anything more than exactly what you have because then you’ll be screwed. As if having bipolar or schizophrenia isn’t screwed enough.
Then there are those of us lucky enough to be “just” depressed, or borderline something, or going through a terrible time. We get therapy twice a month, max. Hope you’re not medicated! And don’t you let that silly therapist talk you into seeing her every single week because, well, you just can’t afford it!
The whole thing is ridiculous. As if choosing a therapist isn’t hard enough, as if treating a mental illness isn’t stressful and exhausting, now we have to worry that our “good” health insurance isn’t going to cover us.
The icing on the cake, for me, is the growing number of therapists who don’t even take insurance. I GET that insurance companies are a pain in the fucking ass. I DO. See above paragraphs. I really get it. But what, pray tell, am I supposed to do if you don’t take insurance? Oh, right! A sliding scale! One that goes to, at its lowest, sixty dollars. Because that’s affordable? I’m already kind of sick to my stomach thinking of the totals for all this therapy. Husband says “We’ll make it work”, but I do the budget in my head and it’s tight. So sixty dollars a session? No. Or I could pay the out-of-network cost! That’s a great deal. I’ll pay eighty percent of your hundred and ninety dollars per hour. I ask you – WHO THE HELL HAS THAT KIND OF MONEY?
(But they’re doing it for the patients, I hear. They spend less time filling out paperwork with the insurance companies and more time with us. Yeah, sure, whatever.)
There aren’t any other options, though. What you could find in the manner of free therapy – if you’re a student or you’re poor, but not those assholes in the middle class, they make too much! – it’s pretty much a joke. Asking a student of psychology to help a person through a major mental disorder or break down isn’t even fair. I agree they have to get real world skills somewhere but just because your poor doesn’t mean you shouldn't have access to a real professional.
I often think of the time I worked for a disability law firm. Their job was to get people Social Security Disability (another joke of a system but don’t get me started). My job was to do basic intake evaluations to prepare them for their meeting with the lawyer. I would ask questions and they would answer. Some of those people didn’t deserve SSD and some of them did. I wasn’t the final decision maker, I just listened.
There were an astonishing amount of those people who were suffering from depression, bipolar and PTSD so crippling that they couldn’t work. Hang on, take a step back – that happens? I mean, if you properly treat all of those things you can still function in society, right? But most of these people were also terribly poor, and whatever “help” they had gotten hadn’t worked.
One woman began crying on me during her intake.
“I just don’t know what to do anymore,” she said, “I’m never going to be better. Things will never get better.”
“Listen,” I replied quietly so that the rest of the room didn’t hear me try to help her, “Things will get better but you have to take care of yourself. Have you gone to the Poor Peoples Therapist?”
I didn’t call it that, but that’s what it was – an association in town that would help crazy people who didn’t have money.
“I tried. I tried but they won’t see me for another three months.”
“And you told them it was an emergency?”
“Yes, but it doesn’t matter to them.”
“I’m sure it does, honey. It’s just…” I didn’t know what to say. I had tried to go there myself once and knew it was incredibly hard to get in to see a therapist. Rumor has it they weren’t very good anyway.
She began to bawl uncontrollably at this point.
“I’ve been waiting two years for my SSD! I can’t afford no medication. I can't do this anymore! No one wants to help me!”
That, right there, sums up exactly how I feel about our mental health care system coupled with the villainous insurance provider. In the end, crying with her now, I urged the woman to go to the hospital and check herself in as suicidal. I had heard that if you admit yourself in the ER they are required to care for you, give you medication and offer you someone to talk to. The only caveat being that you are in a terrifying mental ward and you have to stay for at least two days.
And these are our options. They go from not-great to horrifying, as far as I’m concerned, and there’s no sign of improvement anytime soon.
It’s things like this that make me wish I was still in France. If I could, I would take my mom, move her there and live healthily ever after. But I’d never find a job that paid me as well and we’d be a fucking long way away from everything we’ve built here. So I take what I can get.
Which I think it the moral of the story.
That and “watch out for raccoons, because they’re idiots.”