I am a lurker on Reddit and one of the funnier, if not more ridiculous subreddits is the ThanksObama section. My title from this post is a nod to this section of Reddit, but I am not sure what I am about to write about would be fitting in this sarcastic blame game there. Perhaps there is no sarcasm to be found.
For nearly two years now, I have been regularly seeing mental health professionals on a frequent basis and it has been a costly expense. Neither my therapist nor my psychiatrist accepted medical insurance. This is not uncommon here in the greater Metro DC area. Most mental health professionals around here would rather deal with patients on a cash or check basis. From what I have heard and read, the reason for this is convenience. As any doctor or or medical professional can attest to, dealing with health insurance companies is a nightmare. The irony here is that the head shrinkers would rather the patients deal with the stress of insurance companies than themselves.
Last year was the first time I was on my own plan offered through my company. My insurer is Cigna. In 2013, under the plan I had selected (then called, fittingly enough, POS) I was able to claim my visits to both my therapist and psychiatrist – both of whom were considered “Out-of-Network.” The plan I was under had a $900 deductible and after that out-of-network claims were paid at a rate of 50%. Professional mental health is not cheap, especially in a big city like DC. My therapist charged me $170 for a 50 minute session and my shrink charged $175 for a similar session. For the majority of last year, I saw my therapist on a weekly basis and my shrink every six weeks. This is a tremendous amount of money. Once I was finally able to get through Cigna’s claim system (and I won’t begin to describe how arduous this was), I finally started receiving payments after my deductible was meant and at the rate of 50%. On top of that, the medications that my psychiatrist was prescribing was also part of my plan. I was paying $4 per medication. I also had a Flexible Spending Account, but this is beyond the scope of this post.
Lots of words, blah, blah, blah. How about some numbers. In 2013, my total spent on mental health care came to a staggering $6,660. That is $555 a month. Or, the way I look at things, a monthly payment on a hellava nice car! Of that nearly seven grand, I had to pay $3,780 while Cigna was left with a bill of $2,880, which they had to pay to me. That is still $315 a month.
Then the new year rang in and everything changed.
Towards the end of last year, I was besieged with information stating that EVERYTHING was going to change in terms of my health insurance. Cigna sent me emails, letters, pamphlets, well-laid-out fold-out guides, and voicemails stating that things were a’changin’. I had to login to their website and pick a plan. I choose what most closely resembled my previous plan. This time it was called Cigna’s Consumer Choice – whatever that means. Overall, the plan LOOKED close enough to my previous plan and thought nothing else. This is where I failed to read the small print. As they say, the Devil is in the details.
A week ago, I re-filled my two prescriptions at the CVS near my office. When it came time to pay, I was expecting to pay $4 per prescription, just as I had for the entirety of 2013. Not this time. The total came to over $55. What da faq? The pharmacist assistant offered no explanation when I grumbled. I paid but then thinking maybe the store had an expired insurance information for me, I went back to the counter to verify they had the updated insurance information. They did. So something changed. I went back to the office to research and even called my provider. I verified that the cost for my medications were now being applied to my In Network deductible of $1,500 for the calendar year. In other words, I would have to meet my deductible before my medications were at the previous year’s amount of $4 for prescribed generic drugs. And it was during this research and a confirmation from a representative over the phone that I discovered that my Out-of-Network deductible went from $900 in 2013 to $3,000 in 2014. That is a 233% increase!
Using last year’s numbers, that would mean I would be responsible for a $1,000 more a year. (I think my math is right on this.) What the hell happened?
I know ObamaCare, or the Affordable Care Act, kicked in this year and this changed everything in terms of health insurance. Maybe this is why the sudden and seemingly unexplained drastic change in my health insurance plan. But I am also one to be skeptical. Did it change because of the new law or did it change because my insurer recognized they could get away with the sudden increase by blaming the new law? I am not sure I will ever know the answer to that. I am not sure I want to know the answer.
Look, whether you agree with ACA or not and whether you are a Democratic or a Republican (neither of which I associate myself with), you still have to agree the medical and insurance system in this country if fucked up. Especially compared to the rest of the civilized, First-World nations. Take this video for example and this will tell you everything you need to know about why we are where we are and how we need to fix it. Is ACA the answer? I don’t know. But doing nothing is not solving the problem.
In the meantime, in my own little sphere of the world, I am stuck. I can no longer afford to see my therapist and/or psychiatrist. I will be forced to select an In-Network doctor that accepts my insurance. Completely forgoing the progress I have made thus far in my mental health is just not an option. Nor is a sudden stoppage of my prescribed mental health medications. And I do not feel positive with attempting to find another mental health professional within my area who can a) see new patients and b) accepts my insurance plan.
There are moments when I feel it is just easier to be crazy, sorta like Telsa. At the end of his life, he was penniless, living in a run-down hotel in New York, and in love with a pigeon. A genius who lost his way… But at least he didn’t have to deal with health insurance. Certainly that would have made him crazier, if that was possible.