Yup yup yup. In 14-plus years of I've never found a good psychiatrist who took my insurance AND had availability. I saw some duds who met both criteria but the good ones I've seen I've paid out of network costs. And half the time I don't manage the paperwork to get any reimbursement (thanks to you know, the conditions I'm being treated for). It's exhausting and demoralizing. I've struggled to get in front of someone more times than I can count, and I'm usually pretty high functioning.
I don’t post here but I saw this thread…
I’m in the very same situation. We pay out of pocket for my psychiatrist. I’m thankful that he’s worth it (and that we can afford it). Over the past 20 years, I’ve seen some horrible psychiatrists. It is frustrating.
What I find so hard is once I’ve worked up the energy/courage to call to try to schedule an appointment, the door is often shut in my face or the hoops are too many for someone in a fragile place to manage. One time, I went to the clinic to try to set up an appointment and I ended up bawling in a conference room while the clinic manager worked to help me out.
I can’t speak beyond my personal experience, but in Germany, I had to petition a psychiatrist to see me. He saw me twice and then said that what I needed was beyond his scope of work (depression and ADHD). And then he offered me gummi bears (no joke!). I’m not sure how other countries manage their mental health services, but my guess is that many people struggle all over.
Yep Australia is no different in many ways. You can see your general practitioner who will in a lot of cases give you mess with no other support. Others will use the government health care plan to get you reduced fee counseling services which is a great program if you can find a counselor that will take you in a reasonable time, most have a waiting list.
Mental health services and treatment seems to be potluck in most places
Post by pinkdutchtulips on Jun 30, 2018 0:50:04 GMT -5
2 months from the time I had a consult (actually 2 bc I need a counselor w Saturday appts) to when dd has her first therapy appt ... possible ptsd, gen anxiety and odd issues w dd that I'd like to start getting treatment for ASAP!
I was sexually assaulted several months ago, and when I looked into counseling for that and other issues, I was really appalled that despite paying $600/month for health insurance, I had no coverage for basic counseling. The only mental health coverage I had was for medically diagnosed illnesses or behavioral rehabilitation (addiction or I would imagine depression/suicide) - nothing for people who are just going through some serious or traumatic shit and need someone to talk to. I could have paid out of pocket, but living in a very high cost of living area I was looking at $250/hour. On the advice of some ladies on this board (well, TiP) I contacted RAINN and they connected me with my local crisis center. I got in for counseling, but had to wait a couple of weeks to get in (and I lucked out that one of the therapists had a spot in her schedule open up).
Even now that I have different health insurance and an EAP program, I really hate the way health coverage in this country is so tied into our employers. I don't like even the possibility that my employer knows anything about my medical issues.
I was sexually assaulted several months ago, and when I looked into counseling for that and other issues, I was really appalled that despite paying $600/month for health insurance, I had no coverage for basic counseling. The only mental health coverage I had was for medically diagnosed illnesses or behavioral rehabilitation (addiction or I would imagine depression/suicide) - nothing for people who are just going through some serious or traumatic shit and need someone to talk to. I could have paid out of pocket, but living in a very high cost of living area I was looking at $250/hour. On the advice of some ladies on this board (well, TiP) I contacted RAINN and they connected me with my local crisis center. I got in for counseling, but had to wait a couple of weeks to get in (and I lucked out that one of the therapists had a spot in her schedule open up).
Even now that I have different health insurance and an EAP program, I really hate the way health coverage in this country is so tied into our employers. I don't like even the possibility that my employer knows anything about my medical issues.
EAPs should be confidential, so don’t ever let that stop you from calling. <3
I am very vocal about my mental health issues on social media because if I normalize it, I have always thought it would help someone somewhere. Two people confided in me recently that they were seeking help and I was so damn proud of them. My ARNP that prescribes my meds is leaving his private practice because he can’t afford his OWN insurance anymore.
Reading the above posts makes me wonder - what is the problem with mental health treatment in this country? Is it that there's a shortage of professionals? If so, why is there a shortage - is the field too stigmatized because we still don't consider mental health "the same" as physical health, or is it just due to an overall shortage in medical professionals for other reasons (e.g. the state of healthcare and insurance in this country, etc.)? It's appalling, and even more appalling when you consider how everyone yells "but we have a mental health crisis!!!" anytime there is gun violence and yet those same people crying out about this crisis have no desire to pay for healthcare that would enable everyone to receive the treatment they need and deserve.
I know I went off on a tangent, but reading the stories here just makes me so angry on behalf of anyone who needs help.
There is a major shortage of mental health professionals (especially psychiatrists, but also therapists) who take insurance coverage. Reimbursement is a huge pain in the ass, and reimbursement rates for mental health are particularly low which incentivises self-pay, which is typically somewhat expensive (upwards of $100 a visit). All of this is amplified if someone has Medicaid coverage instead of private insurance because the reimbursement rates are even lower.
Therapists who aren't in private practice make shit money and are usually licensed professionals with masters degrees (so not super cheap training), so that is also a big disincentive to going into the field and to staying in accessible clinic environments.
It's a complicated and multifaceted problem.
Edited for clarity.
Also the need for mental health in this country is skyrocketing. Living in America in 2018 is a risk factor in itself between Trump and his attacks on everyone who isn’t a white heterosexual male, our workaholic culture, instability of the job market, opioid crisis and social media telling you that you don’t measure up. Every health system and every provider network I know of is struggling with the sheer increase in mental illness.
Another issue is that even if you do have insurance, making sure it actually covers not just the treatment you need, but also the frequency and duration you need is very difficult. There are studies that say that there's no discernible difference in outcome between 26 sessions and more than 26 sessions. Yet I know from my own experiences in therapy (on both sides of the room) that often lasting change takes longer.
I think that's another reason so many of us go into private practice. To be able to provide what we think is best for our clients instead of having insurance companies dictate it.
This is also an issue for hospitalization and, for minors, residential placement for intensive treatment. There is so much wrong with how mental health is treated in this country.
I was really appalled that despite paying $600/month for health insurance, I had no coverage for basic counseling.
This is what's wrong with healthcare. Despite us paying so much OOP for coverage, the money is not going to the doctors with the knowledge and skills to provide the actual healthcare. It's a horrible system. The people in the suits take it all home.
I have twice helped a friend (the same friend) to get needed inpatient treatment. This friend is incredibly smart, very knowledgeable about mental health issues, usually med compliant, and is actively seeking the help. Even so, it's been a nightmare both times and exponentially worse the most recent time (this year).
Every step was painful and unnecessarily difficult, from just getting in front of a doctor to getting to the right doctor to finding appropriate post-inpatient support to insurance to FMLA leave approval. Everything was draining and there was NO easy coordination between anyone. I was not in the middle of a mental health crisis myself AND working with my friend's siblings who are amazing and still nearly broke down several times.
Every single aspect is broken, so I don't even know where to begin with ideas for change.
My son had ADHD, anxiety, and high functioning autism, and trying to find help for him has been a miserable challenge. Our insurance specifically disallows speech and OT that's not "medically necessary" and we can't afford to pay for it out of pocket indefinitely so he's already being denied all the therapies that good parents get their kids. Once he got a little older and better at expressing himself I decided to try going though the mental health system to get him a counselor because so many out here say they work with kids with anxiety and ADHD but the second I mentioned the autism then noped the fuck out and declined to take my son as a patient. After weeks of hunting I finally found an intern who will take him but we have to pay out of pocket so we can only afford for him to see her twice a month and because his appointments are on weekends they are constantly getting moved or postponed because of holidays. I constantly feel like I've failed him by settling instead of continuing to try for someone who might take our insurance.
The whole system is fucked. We pay around $600 a month for a plan that doesn't cover what my child really needs and because of copays we have to ration mental healthcare for the family. My husband and I both have problems with depression and anxiety and the last couple of years have been rough for both of us. After paying for DS's therapy and the family's medications we only have room in the budget for one person to get weekly counseling sessions because we can't afford for everyone to full service care at the same time. I have better coping skills than DH does so he sees a counselor and I just scream into a pillow and cry in the shower when it gets to bad.
You are so right. As a school counselor who unfortunately sends kids for crisis intake often, the amount of resources available is very low. And the resources that do exist usually have long waiting lists or very high price tags. It is so incredibly hard .
Where are you? I have become a little bit of an expert at teasing out options in different areas. I'm a military spouse, so I've been a counselor all over the US and have seriously seen it all. If I can help let me know!
Post by notsocreepylurker on Jul 3, 2018 11:08:58 GMT -5
How timely this thread is.
I've been struggling bad for the last 6-9 months. I was taking Cymbalta AND Wellbutrin and I feel they both stopped working. It takes all of my mental energy to shower daily and make sure my cat has food and a clean litter box. I have almost nothing left after that.
I had a doctor appointment last week for blood pressure check and doc asked about everything and I was like oh yea, the meds stopped working a LONG time ago. So he wants to switch me to a new med, a non-formulary one. Insurance won't cover it. He's fighting with them. If I pay OOP it is $500 for 1 month and we don't even know if it'll work. So I wait. Hoping insurance will cover it so I can hopefully get some relief.
And I don't even have it as bad as many others. And I know that. I have good insurance and a doctor willing to fill out a lot of extra paperwork.
I've been struggling bad for the last 6-9 months. I was taking Cymbalta AND Wellbutrin and I feel they both stopped working. It takes all of my mental energy to shower daily and make sure my cat has food and a clean litter box. I have almost nothing left after that.
I had a doctor appointment last week for blood pressure check and doc asked about everything and I was like oh yea, the meds stopped working a LONG time ago. So he wants to switch me to a new med, a non-formulary one. Insurance won't cover it. He's fighting with them. If I pay OOP it is $500 for 1 month and we don't even know if it'll work. So I wait. Hoping insurance will cover it so I can hopefully get some relief.
And I don't even have it as bad as many others. And I know that. I have good insurance and a doctor willing to fill out a lot of extra paperwork.
Have you looked ones to see if there is a discount card for the medication? Both DS and I take medicines that are not covered by insurance and would be completely unaffordable to us if we weren’t able to get copay support from the manufacturer. Try googling “drug name coupon” to see if there is help out there. It’s an extra crappy hoop to jump through when you already feel like you’re drowning but this might be the right medication for you. Even with copay support I still pay more for my Trintellix than anything else but it’s been a lifesaver.
I've been struggling bad for the last 6-9 months. I was taking Cymbalta AND Wellbutrin and I feel they both stopped working. It takes all of my mental energy to shower daily and make sure my cat has food and a clean litter box. I have almost nothing left after that.
I had a doctor appointment last week for blood pressure check and doc asked about everything and I was like oh yea, the meds stopped working a LONG time ago. So he wants to switch me to a new med, a non-formulary one. Insurance won't cover it. He's fighting with them. If I pay OOP it is $500 for 1 month and we don't even know if it'll work. So I wait. Hoping insurance will cover it so I can hopefully get some relief.
And I don't even have it as bad as many others. And I know that. I have good insurance and a doctor willing to fill out a lot of extra paperwork.
Have you looked ones to see if there is a discount card for the medication? Both DS and I take medicines that are not covered by insurance and would be completely unaffordable to us if we weren’t able to get copay support from the manufacturer. Try googling “drug name coupon” to see if there is help out there. It’s an extra crappy hoop to jump through when you already feel like you’re drowning but this might be the right medication for you. Even with copay support I still pay more for my Trintellix than anything else but it’s been a lifesaver.
Trintellix is what my doctor is trying to get me to try (if insurance will pay). I got a card from the office that says its from Trintellix - says pay no more than $10 or whatever. When I asked Walgreens about the price without insurance I asked about the card and they said the card is to be used AFTER insurance.
They have to run it through insurance, get it rejected, then they can apply the coupon. Our pharmacist is awesome and explained the process to me. Just make sure that you fill out the forms online before you bring them into the pharmacy. It’s easier than it sounds and a faster process than fighting insurance
They have to run it through insurance, get it rejected, then they can apply the coupon. Our pharmacist is awesome and explained the process to me. Just make sure that you fill out the forms online before you bring them into the pharmacy. It’s easier than it sounds and a faster process than fighting insurance
Yup! This should work. And if thar pharmacist is going to be annoying about it try another pharmacy if you have access to one.
Trintellix is what my doctor is trying to get me to try (if insurance will pay). I got a card from the office that says its from Trintellix - says pay no more than $10 or whatever. When I asked Walgreens about the price without insurance I asked about the card and they said the card is to be used AFTER insurance.
Now that you mentioned this, I think my doctor had me try this like 1.5 years ago. She gave me a bunch of samples because she said insurance usually doesn't want to cover it. It made me really nauseous however so I didn't stick with it so I never did get to find out if mine would cover it.
Trintellix is what my doctor is trying to get me to try (if insurance will pay). I got a card from the office that says its from Trintellix - says pay no more than $10 or whatever. When I asked Walgreens about the price without insurance I asked about the card and they said the card is to be used AFTER insurance.
Now that you mentioned this, I think my doctor had me try this like 1.5 years ago. She gave me a bunch of samples because she said insurance usually doesn't want to cover it. It made me really nauseous however so I didn't stick with it so I never did get to find out if mine would cover it.
Cymbalta has some really bad side effects when starting/ending it. Most common is severe nausea. I somehow had NO symptoms starting it. My poor friend got the 2 weeks of severe nausea.
I feel very fortunate to have an MD who is in network and I can easily get appointments. I had to beg their office a little in the beginning to get them to take me as a patient since I didn't have a direct referral from my OB, but they took me maybe because I worked nearby? It's been harder to find a therapist however. I went to one recommended by my primary doctor and she just kept obsessing the whole time that she was out of network for me. Her cash fee was affordable and I would've been happy to pay it, but it's like she didn't know what to do with me because all her patients are in-network around here. The whole experience just turned me off. My friend's sister just opened up a private practice as a therapist also in this area. She is busy with patients from insurance alone.
After a few different therapists and finally finding a great fit, he just informed me he is leaving his current practice. He cannot tell me where he is going so I have to wait until it is public knowledge (online) to see if his new practice is covered under my insurance.
After a few different therapists and finally finding a great fit, he just informed me he is leaving his current practice. He cannot tell me where he is going so I have to wait until it is public knowledge (online) to see if his new practice is covered under my insurance.
FUCK!!!!!!!!!
When is he leaving? You might check your insurance provider list now as he might have already gotten paneled at his new place. You could also challenge his current practice's ethics on this as therapist relationships are different than those with other health care providers, especially given that you've gone thru other providers before connecting with him.
After a few different therapists and finally finding a great fit, he just informed me he is leaving his current practice. He cannot tell me where he is going so I have to wait until it is public knowledge (online) to see if his new practice is covered under my insurance.
FUCK!!!!!!!!!
When is he leaving? You might check your insurance provider list now as he might have already gotten paneled at his new place. You could also challenge his current practice's ethics on this as therapist relationships are different than those with other health care providers, especially given that you've gone thru other providers before connecting with him.
Thank you for the advice. After a few near tears moments the office told me his new facility and I immediately called my insurance company. Thank God, he is still covered.
He is about 15 miles away now as opposed to the 3 miles currently but I will survive.
When is he leaving? You might check your insurance provider list now as he might have already gotten paneled at his new place. You could also challenge his current practice's ethics on this as therapist relationships are different than those with other health care providers, especially given that you've gone thru other providers before connecting with him.
Thank you for the advice. After a few near tears moments the office told me his new facility and I immediately called my insurance company. Thank God, he is still covered.
He is about 15 miles away now as opposed to the 3 miles currently but I will survive.
Post by notsocreepylurker on Jul 8, 2018 8:35:28 GMT -5
Just wanted to update on my new prescription. Insurance finally covered it. Instead of the $500 for 30 days I will now pay $187 for 30 days. Luckily I can afford this. But I know lots of people who could not.
Post by orangeblossom on Jul 8, 2018 13:41:03 GMT -5
itsmyparty I am so very sorry you were sexually assaulted. Maybe a rape/sexual assault centering your area can help you with counseling at little or no cost. I agree, you shouldn’t have to go through your EAP to get help. Hugs and good luck.
National Sexual Assault Hotline 1-800-656-4673 Rape, Abuse and Incest National Network · rainn.org
Just wanted to update on my new prescription. Insurance finally covered it. Instead of the $500 for 30 days I will now pay $187 for 30 days. Luckily I can afford this. But I know lots of people who could not.
That's great. You may still want to try the coupon. I'm on a med that costs $75 after insurance. I then use the coupon which knocks it down to $25.
Just wanted to update on my new prescription. Insurance finally covered it. Instead of the $500 for 30 days I will now pay $187 for 30 days. Luckily I can afford this. But I know lots of people who could not.
That's great. You may still want to try the coupon. I'm on a med that costs $75 after insurance. I then use the coupon which knocks it down to $25.
Actually - the card from the manufacturer saved me another $100 so I only paid $88
Just wanted to update on my new prescription. Insurance finally covered it. Instead of the $500 for 30 days I will now pay $187 for 30 days. Luckily I can afford this. But I know lots of people who could not.
You can still use the coupon. My Lyrica is 35 month but use their coupon each year and pay 25 for a 3 month supply. The pharmacist should have the card to run through
Just wanted to update on my new prescription. Insurance finally covered it. Instead of the $500 for 30 days I will now pay $187 for 30 days. Luckily I can afford this. But I know lots of people who could not.
You can still use the coupon. My Lyrica is 35 month but use their coupon each year and pay 25 for a 3 month supply. The pharmacist should have the card to run through
I was able to use the card - saved me $100 so I only paid 88
You can still use the coupon. My Lyrica is 35 month but use their coupon each year and pay 25 for a 3 month supply. The pharmacist should have the card to run through
I was able to use the card - saved me $100 so I only paid 88