Let me start this post by saying I am lucky. I am lucky because, unlike many people I know and come into contact with, I have health insurance. And, really, I have good health insurance. This puts me at a distinct advantage over many of those who have either a mental illness or chronic illness. It lets me have a peace of mind that often is missing for those with long-term illnesses. If you look at the statistics, roughly 56.5% of people in the United States live with an untreated mental illness in the United States and over 50% of those receive no treatment because they have lack of funds or insurance. Over 17% of people with a mental illness in the United States are not insured. However, even those that have insurance may not be able to afford the costs associated with mental health care.
With that said, though, in light of current conversations around healthcare in the United States, I wanted to highlight the problem with getting mental health coverage and what it actually costs. This is especially in light of Rep. Chaffetz informing us all that we should stop buying iPhones and get health insurance.
I want to begin this discussion by saying I will be using myself as an example. I have three primary places where my money is spent in regards to my ongoing recovery: medications, therapy/counseling, and psychiatry. Many people find it interesting that I see a separate psychiatrist and therapist/counselor. However, the two do different things. The psychiatrist prescribes medicine and diagnoses, while the counselor helps with coping and living life with a mental illness by engaging in talk therapy. The two fulfill different roles and both are needed to have successful recovery from mental illness.
Another caveat to make is that my insurance gives me a “discount” on medications. So, it would cost more (much more) if I were to simply by the medications out of pocket. For example, one of my medications would cost me $717.30 each month without insurance. And, that cost has actually gone down because there is now a generic version of the drug. But, with my insurance, I pay about $120 each month for the prescription. This is, of course, a significant “discount”.
(I put discount in square quotes because it comes from the fact that my family pays a rather high premium each month. I do not save any money by having insurance and the discount is basically my insurance company negotiating the price with the drug company. It’s not a true discount as much as it is me paying for the right to buy it at a lower cost. A true discount would not require you to buy the right to buy a product at a lower price).
So, in a month, I spend about $400 on my four psychiatric medications. I take a mood stabilizer, an anti-psychotic/anti-depressant, a pure anti-depressant, and another anti-depressant that also acts as a sleeping pill. Only one of my four medications is not a “name-brand”, so I am extremely lucky in that department.
In that same month, I pay between $70 and $160 on my therapist. And this is things start to get a little weird. My insurance does not always apply my therapist appointments to my deductible. This means that I still get the discount but get no credit. So, to make this clear, my therapist charges $120 for an hour of therapy. My insurance has “negotiated” with him and in those negotiations told him that they will only pay him $80. But, I still have a co-pay of $35. But, if I have not reached my deductible, I have to pay the $80. So that’s how my therapist gets paid by me and the insurance company.
However, for some unknown reason, the insurance company has not been applying my visits to the therapist to my deductible. So, my biweekly pay out of between $35 and $80 does not go towards my year end total contribution, does not help me meet my deductible, etc. etc. And there does not seem to be a reason for this decision on the part of our insurance company. Just because. Which is terrible because at minimum that would be $910, or 18% of my contribution towards my deductible and total out of pocket.
(At this point, it may be important to explain how my deductible works and total contribution. Essentially, I have a deductible which means that I have to so much money before I start being able to simply pay a copay. So, my copay for the therapist is $35. When I pay all that I am supposed to towards my deductible, I can then pay $35; before that, though, I am responsible for $80. However, on top of this, I have a total contribution, which is an amount that if I reach, I am only responsible for this much. Once I hit my total expected contribution, I no longer have to pay for healthcare services, my insurance will pay the full freight. The catch is that this is so high that unless I have a major injury or surgery or something, I am unlikely to meet it.)
The last piece of my mental health care puzzle is my psychiatrist. I see my psychiatrist about every 3 months. The nature of my bipolar is that this is about how often I need to be “checked-in” on. The cost for this meeting with the psychiatrist is about $165. My insurance, though, has also negotiated with this office and said they will only pay $120. So, I then have to pay $120 each time I see the psychiatrist, with the understanding that I have not hit my deductible or total expected contribution.
All figures, so far, have been for this year.
So, on top of the premiums my family and I pay for our insurance, just my mental health care costs, at minimum, are the following:
Prescriptions: 12 X $400 = $4800
Therapist: 26 X $35 = $910
Psychiatrist: 4 X $120 = $480
Total = $6,190.
So, for Rep. Chaffetz, my iPhone, brand new without a contract, costs $750. I could buy 8 full iPhone 7’s for the cost of just what I pay out of pocket to stay well. That’s about an iPhone every 6 weeks. And this does not even come close to the total amount I pay for premiums. And, if I get hospitalized, well I am prepared to start the bankruptcy proceedings.