The Costs of Mental Illness, With & Without Insurance
by Crystal Kopp
Money problems and mental illness: two subjects still taboo in our increasingly open and accepting society. What makes these even worse is how often they are intertwined and one of the biggest places this happens the cost of treating them.
When I was fourteen I went into therapy for what would be the first of many times. I did think of the cost of such health care then. I was on my dad’s insurance; he paid the copays. When I was nineteen attending community college, I entered therapy again. While I was still on my dad’s insurance, I was working part time and paid my own copays. When I transferred to a four year college I was so excited to learn they had a free counseling center. I spent three years with the same therapist and was introduced to a psychiatrist who prescribed Effexor XR.
There was no generic for this ten years ago and even with my dad’s insurance it was $75 for a month’s supply. In the world of pharmaceuticals I know this isn’t much, but when you’re going to school full-time on full scholarship, no loans, and working a part time minimum wage job, $75 a month is a large chunk of cash. Nights out with friends revolved around half price appetizer hours, 2 for 1 drink specials and waiting for movies we wanted to see to hit the dollar theater. These are regular college student cost cutting methods I realize, but when it comes down to “if I eat out tonight with my friends I can’t afford the pills I need” you spend a lot of nights eating on your meal plan instead.
Upon graduating in 2007, I was 23 and kicked off my dad’s insurance (you Obamacare kids are so lucky). I was faced with the reality that my new day job of substitute teaching didn’t offer insurance nor did that part time job I still held and I had brand name prescription. I was fortunate enough that my college therapist informed me about a reduced cost mental health clinic in the area. Like most underfunded health resources for the poor and uninsured it was suspect, understaffed and the staff they did have overworked. The psychiatrist volunteered his time once a month and time slots were often triple booked months in advance to fit in as many people possible. As a result I spent many hours in the dingy, crowded waiting room reading books, missing a day of subbing to get see him. It was $15 to see the psychiatrist and $15 for a three month supply of your medication through the pharmaceutical’s prescription assistance program. Often times there were delays with getting your three month supply in which the nurse would supplement from the locked cabinet of never ending samples. Sometimes she would give me a whole bottle of my prescription for free and when I’d ask about it she always waved it off and said, “The reps will just bring us more.”
I continued going to this clinic until 2009 when it shriveled up because a psychiatrist could no longer volunteer his time due to health issues. I was fortunate enough that the office job I obtained in 2008 started offering insurance before I ran out of my last $15 three month supply. I found a psychiatrist who took my insurance and he changed my prescription to Cymbalta, another drug without a generic. This insurance plan had a $500 deductible that had to be met before they would cover any prescriptions. This was easy enough to meet since I had to pay retail for my 30 day prescription of Cymbalta and that was a little over $300. When the pharmacist ran my order up, I cried. $300 was half my paycheck! And I still my car payment and other bills to think about. Of course by the end of the year, I was paying $0 for my prescription but with the new insurance year around the corner I had to plan and save for that initial $300.
In 2012 I got a new job in the corporate offices of a local chapter of a non-profit organization. While I was paid more an hour and in a work environment that wasn’t toxic and actually appreciated me, they did not offer insurance. It was also this time my psychiatrist sold his practice because he was offered a teaching position at a university based on all his work on addiction. While I got on the list to see the new psychiatrist, I started seeing a therapist with the same company. Since I was still without insurance, I was paying $125 a session to see my therapist twice a month and $95 for fifteen minutes with my new psychiatrist every 2–3 months. I had to plan for this money just like it was another bill.
I often grew resentful and angry with my mental illness. That was $345 I could have put in that nonexistent savings account financial blogs tell me I’m supposed to have. Why was life so unfair? The manufactures of Cymbalta at least had a prescription assistance program I qualified for and I was able to get that pill for free. The Lamotrigine I was put on for my newly diagnosed bipolar was luckily generic and I could afford to get it at the pharmacy.
Then the end of 2013 happened and Obamacare was around the corner. I qualified for a significant tax credit and picked a silver plan that covered what I needed mental health-wise. My portion was only $154 a month; my $125 therapy sessions went down to $30 as did those $95 psychiatrist appointments. In February Cymbalta went off patent and I was switched over to the generic since I no longer qualified for the prescription assistance program now that I had insurance. Besides, the generic was only $4 with my insurance. Things were looking good mental health- and money-wise. But it didn’t stay that way.
In the middle of October, HR informed us that starting November 1st they would offer us insurance. I made a joke that they were probably tired of paying the Obamacare fee and that insuring us would be cheaper. In the weeks leading up to the 1st, I met with the brokers they brought in to pick a new plan out of what was offered. While the broker informed me that most of my coworkers were going with the cheaper monthly bronze plan, I took a look at it and realized it wasn’t for me. I couldn’t afford to pay full price on my appointments until I met a $5,000 deductible.
So I went with the silver plan with set copays. Even after my therapist suggested a few brokers to see if I could get a cheaper plan outside of work, they weren’t cheaper. I sadly canceled my awesome Obamacare silver plan and settled into my work ‘s silver plan. I am now paying $262 a month for insurance and $50 for my copays. My pills at least only went up about $10 each.
It’s easy to get upset with how much I spend on these things, but that’s not — ha! — healthy. I have to learn to accept that this is part of my life, health and money wise. Therapy sessions and medication will forever be a part of my budget the way insulin is part of a diabetic’s life. Yes, it’s frustrating, and puts a damper on other things, but despite all the costs I can add up my health is priceless.
Crystal Kopp is candid about her type II bipolar, her love of cats, and that she lives with her parents. She’s a recovering shopaholic slowly but surely taking control of her finances. She just finished the first draft of her novel bringing her one step closer to achieving the dream she’s had since she was six of being a published novelist.
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