My Experience Only. YMMV.

Posts tagged ‘health insurance’

Shortchanged: Bipolar Disorder and Money

I don’t know any rich people with bipolar, aside from the celebrities who struggle with it and go public. There may be some out there – there must be, statistically – but I don’t know any of them. I’m relatively well off – home, car, most bills paid, work – but even I live paycheck to paycheck. And have lived no-paycheck-to-no-paycheck in the past.

Let’s face it, having bipolar is expensive. And not conducive to making money. Here are some of the hurdles that I’ve noticed.

Insurance. The biggie. Right now I have insurance and, thanks to the Affordable Care Act (Obamacare), it covers mental health conditions. My previous insurance, which was more expensive, and crappier, and came through my husband’s employment, did too, but not nearly as well.

So, I’m covered, but not all my doctors take my brand of insurance. Some of them will accept reduced fees (if you ask) or have a special self-pay rate. But even that doesn’t always help much. My previous psychiatrist charged me $95 and my current one $75 – and those are just for 15-minute med checks, not full 50-minute sessions. My therapist accepted $30 per for that, so I was lucky, but had no official insurance document stating that she had to give me that rate.

Medication. The other biggie. I am currently on four or five psychotropic medications, depending on how you count (and no, you don’t need to know what they are: http://wp.me/p4e9Hv-u1). One of them – you can probably guess which one – cost $800 per month when it was first prescribed to me. I got a coupon from GoodRx.com that brought it down to around $200 per month which was, if not exactly reasonable, more doable. Finally, a generic came out and the ACA kicked in, and I get the drug for $45 per month now. That would have seemed high at one time, but now sounds comparatively reasonable. But if you’re on a fixed income, watch out. Fixed income and no insurance, you’re screwed.

SSDI. Which brings us to the topic of Disability, the “safety net” that’s supposed to catch those of us who are so disabled by our mental (or physical) conditions that we’re unable to work. Good luck getting it. Most people who apply are rejected, sometimes more than once. Practically speaking, you need a lawyer to navigate the shoals for you, and one who works on contingency at that. The hoops and red tape are massive. If you’ve got depression, to pick just one example, cutting through and jumping through may be beyond your capabilities. You’d think they planned it that way, just to cut down on the number of claims they have to pay.

Mental illnesses are particularly difficult to get SSDI for. They’re “invisible illnesses,” not like blindness or paraplegia that one can’t help but notice. When and if you do get approved, the monthly payment is meager and fixed (see above), unless there is a cost-of-living raise which, given the current economy and political leadership, is increasingly unlikely.

Bipolarity. Then there’s the disease itself. Anyone with mania can probably tell you about the sometimes-ruinous spending sprees that accompany racing moods. Hell, I only get hypomania and I’ve got five custom-made dresses in my closet that I’ve never worn and now can’t because of weight gain from my psychotropics.

You’d think depression would not have much effect on your spending. But it does have a profound effect on your income. People with bipolar depression who can work part-time or from home are lucky. Others not so much. There was a period of several years when I was unable to work at all, and we ran through our savings and retirement accounts rapidly. My husband could still work, but one income quickly became insufficient to meet the bills. (Fortunately, my bipolar depression lifted enough that I’m now able to do part-time, at-home, freelance gigs, which are about as unstable as I am.)

Retirement. No IRAs left. No savings. That means Social Security, delayed as long as possible, and the aforementioned fixed income. Basically, I can never retire. I can’t afford to.

Frankly, I can’t see any of this changing anyways soon. Money trouble is just one of those things that you have to deal with along with your mental disorder. And there’s nothing like stress to make your symptoms worse.

But What Happens in January?

Health insurance is a hassle, especially when you’re talking about mental health. And it’s an even bigger hassle when the government gets involved. That’s not necessarily a bad thing, but it does add a layer of complexity to the insurance process.

For quite a while I was uninsurable, or functionally so. My husband and I both had decent insurance when he worked for the county, but after he left that job, it was all downhill. We muddled through without coverage, paying for our meds out of pocket and avoiding the doctor’s office unless death seemed imminent or we had to have blood work. Mammograms, flu shots, and other preventive services fell by the wayside.

Then came the Affordable Care Act, aka Obamacare. Our pre-existing conditions were no longer a factor. My mental health coverage was guaranteed without going through the county’s EAP plan (Employee Assistance Plan, a six-week, take-the-therapist-we-give-you, cure-’em-quick affair).

The only problem (well, the major problem) was that, even with the ACA subsidy, the insurance cost us $650 per month. And my doctor started prescribing Abilify (cost: $800 per month, and wouldn’t you know, it wasn’t on the insurance plan’s formulary of preferred drugs). Fortunately, the generic came out soon after. It still wasn’t cheap, but it was somewhat lower.

The next year we switched plans. Unfortunately, the new company, a co-op, went under and we were transferred to yet another plan. It was no better than the previous one. In many ways, it was worse.

Prescriptions, for example. After getting them filled at our pharmacy for a certain number of months, we were told that almost all our meds MUST be ordered for home delivery, or the insurance company would not pay for them.

Which would be fine, as they were maintenance drugs. Except that meant paying $1100 for three months of generic Abilify, in addition to the monthly premium for the insurance. I can’t scrape together a lump sum like that, so through GoodRx coupons (https://www.goodrx.com/?c=criteo_au&utm_campaign=activeuser) and the local Kroger, I managed to get my prescription for under $200 per month.

Then the real fun started. My husband’s meds and my non-psychotropics went through the mail-order system easily. The ones my psychiatrist prescribed, not so much.

I’ve just spent the time between November 19 and now trying desperately to get the mail-order place and my doctor’s office to talk to each other, fax each other, send smoke signals or carrier pigeons to each other, to get me my drugs. As I gradually ran out of meds, which I’ve written about before (http://wp.me/p4e9Hv-kO).

I finally got a little action when I went to my doctor’s office, camped out in the waiting room, talked to one mail-order person on the phone while the receptionist talked to another one on another phone, and the nurse worked the fax machine. Then I went home, called mail order again, jumped up and down, threatened to hold my breath until I turned blue, asked for the supervisor, talked to the actual pharmacist, and almost burst out sobbing. Yesterday I got my pills.

This time when I had to pick a new insurance plan or renew my old one, I found one that was almost exactly as crappy as our previous one, but at one-third the cost. And the company representative says that all generics can be bought, at either the pharmacy or via mail order, at the same low co-pay. Including generic Abilify.

We’ll see.

The next problem is, as I’m sure you’re all aware, the president-elect and Congress have sworn to repeal Obamacare as soon as they get into office, whether or not they have a plan to replace it.

What will happen then?

Will I be able to get affordable insurance?

Will I be able to get insurance at all? (Even crappy insurance is better than none.)

Will it cover mental health services? Outpatient? Inpatient? Both psychiatrists and psychotherapists?

Will it cover psychotropic drugs at the same rates as others? Or will the meds that really work for me not be in the formulary of preferred drugs?

And how long will it be before even the crappy, but lower-cost, insurance that begins on January 1st, disappears?

I’m guessing (hoping) that our insurance won’t vanish immediately, given the pace at which the government usually moves. But repealing Obamacare (though not replacing it) has been touted as one of the first things the new administration will do. And anxiety is one of my psychiatric problems. How long will I have to wait, unknowing, to learn what those answers will be?

Generally, I have anxiety when I don’t know what’s going to happen. I catastrophize, then feel at least a little better when the answer comes. (It’s usually not as bad as I had anticipated.)

But this time, when the answer comes, will it lessen or increase my anxiety?

And will I be able to afford the medicine that keeps my anxiety in check and the psychiatrist who prescribes it?

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