Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Friday, February 16, 2007


Insurance stinks. As a healthcare professional you get used to that fact pretty quickly as you spend a lot of your time fighting with it, complying with it even when it is against what you want/need, rolling your eyes, etc. I deal mainly with Medicare and Medicaid, and between the two of them there are enough rules to make anyone confused on a daily basis, and they change all the time. All kinds of things make no sense, like there are times when it is better to be on Medicaid than to have money of your own or private insurance. Actually that's often true. Unless you need other things, in which case forget it. Or Medicare sets one chunk of amounts we are paid for services and Medicaid sets another. Medicaid's payments are so low that it actually costs my company money for me to treat a Medicaid patient.

However, one benefit of working in this field and of there being a high need for therapists, is that we generally have really good insurance. Just like everyone it's gotten worse and worse, and just in the last 3 years mine has significantly gotten worse, except that it improved in some ways because for a while my insurance did not cover mental health, including psychiatrists, until a $10000 mental health deductible was met. That's not a typo, and that would be a more than average hospital stay for psychiatric treatment paid out of pocket before a dime was paid. At that time I paid everything left after the doctor took off the negotiated fee chunk. That left me paying $45/month. At that time I also paid about $200/month for prescriptions and I was taking 7 meds, nearly all of which were not generics. One prescription alone would have cost $1000/month and it was covered except for $15 of co-pay.

For the last few years I had a little bit of coverage for counseling (They paid about 70% of 15 visits). The psychiatrist was $25/visit. Generics were $10 and name brand meds were $15. Labs were covered at least 80% (for a while 90%). My meds cost around $200/month and I really don't know how many I was on at an average because I've had many changes.

When I took this job my insurance was just about the same as my previous job. There were a few things that were slightly more expensive, but the out of pocket deduction was far less, and the changes were miniscule. Then this year they altered the plan. The out of pocket deduction was only changed a tiny bit, but the co-pays suddenly are ridiculous. Each psychiatrist visit is $50. That is monthly. I have such minimal counseling coverage that the center recommended not using it and going on the no-insurance, high need program they have. The meds are the worst part. Generics are $15 and name brands are suddenly $40. One of my meds my doctor had to fight for approval for, and even with that I have to pay $60 per month. My out of pocket med costs, despite being on less medication than ever before, is currently at as much as it was with the maximum number of meds I've been on.

I'm also constantly fighting with my insurance. Before vacation I had to fight with them because they could not comprehend that if the number of pills I took per day of a given prescription doubled then I would need to fill the script early at the new dose. They tried to charge me $300 for a refill. It took 3 phone calls to fix that one.

This makes me afraid of what is to come. I am feeling really good on this current medication strategy, but what happens when that changes? What if I need 7 or 10 meds again, and if I do what if they are brand names? I'm very fortunate right now that I've done very well on a very old antidepressant that is very cheap for a long time, but I do well tenuously; the dose I take now may well make me manic soon, and 6 weeks ago a teeny amount less had me quite depressed.

Sometimes I wonder what would happen if we didn't have insurance at all. Not the whole socialized medicine thing, but if healthcare were just another industry, something everyone used, like deodorant manufacturing or something. I wonder if trying to make it manageable just makes it worse.

What we have now just doesn't work.