The Cost of Having A Mental Health Condition

Health care costs are skyrocketing making it difficult for people to access the care that they need.

According to an article released in March 2019 from the American Public Health Association

• Two-thirds of people who file for bankruptcy say that health care costs were a main cause of their financial difficulties.
• The research shows that the Affordable Care Act has not improved things despite gains in coverage and access to care.
• Academic researchers found that 66.5 percent of all bankruptcies were tied to health care costs.
• An estimate of 530,000 families turn to bankruptcy each year due to unpaid medical bills.

Researchers say that insurance issued by employers, or what is available and affordable to people is not providing adequate protection when an illness or injury occurs. The research included 910 Americans who filed for bankruptcy between 2013 and 2016. 

Most families in America do not have enough money saved for a simple emergency, so paying for thousands of dollars in medical bills is just not an option. Some people cannot afford the medication that they need, and either have to ration out their meds or make due without. According to a recent report, U.S. Health care costs soared to $3.65 trillion in 2018, which averages out to roughly $11.121 per person. PER PERSON YOU GUYS.

Prescription drug prices frustrate many people that I talk to about health care costs. In 2018, the cost of prescription drugs purchased in retail pharmacies went up 3.3 percent in 2018, which is much higher than the 0.4 percent it increased in 2017. It seems like with insurance, your out of pocket cost for medications is always surprising, and usually jaw-dropping. And, even if you use a prescription discount coupon like GoodRx, the cost of medications alone can cause people to drown financially.

I am not a stranger to the nightmares of ballooning medical costs. As someone with a mental health issue, costs can be even higher. Mental illness is still widely viewed as something separate from physical illness. Insurers can be not so forgiving when it comes to costs associated with mental health care, and many have been denied coverage due to a treatment being deemed "medically unnecessary" by insurers. So unfortunately for many who suffer from mental illness, having insurance does not automatically mean that they will have access to affordable mental health treatments.

Insurance companies are in the business of making money. The top way they make money is when the people that they insure do not actually receive care. Even though this is not a good look, it is the basic business model of insurance companies. If they are obvious about it, things will look even worse for them. So insurance companies are very good at employing subtle and sneaky ways to make receiving care more difficult. Especially when it comes to mental health care. Insurers often require pre-authorization for inpatient care. And when it comes to outpatient care, they often offer lists containing a small amount of in-network providers and penalize people who see someone out-of-network by requiring them to pay more money for their treatment, if the insurer pays anything at all. Most don't pay anything when it comes to out-of-network providers. In my experience, with "in-network provider lists," the lists is comprised of names and phone numbers of providers who can't help you, don't call you back or end up not actually accepting insurance.

Despite two Federal laws that were designed to bring parity between mental and physical health care coverage, many patients still struggle to get the mental health coverage that they need. Insurance companies can no longer write policies that charge higher co-pays or deductibles for mental health care, and they can't set annual or lifetime limitations on how much they will pay for mental health care. But, they still scrutinize claims for mental health treatments much more that those for physical treatments. So, often when insurance companies review claims for mental health they deem the treatment to be unnecessary and the claim gets denied. They use various methods to determine whether a type of treatment is medically necessary or not. Things like not meeting medical criteria, utilization review, prior authorization and step therapy are some of the most common reasons why insurance companies deny claims. Usually, you can appeal the denial if you feel like you should be covered for the treatment. It is a frustrating, and usually long process which results in more time that you are not receiving treatment. According to the National Institute of Mental Health, 6 in 10 people with mental illness just go without treatment or medication.

My health insurance is CIGNA. They just recently sent me a letter to inform me that that starting January 1, 2020, they will no longer cover my current dosage of a certain medicine that I take. I currently take one 30mg pill twice a day, and they have covered that dose and frequency for years. They do not explain in the letter why they have decided not to cover it anymore, but I have a feeling that it has something to do with cost. This particular drug is the most expensive one in my current medication regime. They did explain that I could have my doctor contact them to explain why it is medically necessary for me to remain on my current dose. Lucky for me, it is very easy to contact my Psychiatrist, and she confirmed that she would contact them. If I get denied, I will most likely be forced to change medications to continue to achieve the results that I am receiving with my current medication. The idea of changing medication after being on a certain one for years is super frustrating, and I find it very annoying that the insurance company did not fully explain what the issue is. But, as I was explaining earlier, insurance companies are employing subtle and sneaky ways to deny coverage so that the money stays in their pocket. By them sending me a letter they are hoping that I won't go through the trouble of contacting my doctor, or that my doctor won't find the time to contact them. It's unfair.

Now that I have talked about how ridiculously overpriced health care is, and how unfair and unpredictable mental health care can be in our country, I want to to talk about my personal experience. 

Years ago I was diagnosed with major depression, anxiety and ADHD. I am under the care of a Psychiatrist, who I see every three months. This year however, I have seen her an extra two times due to medication changes and adjustments. This year I also tried to find a therapist. After finding one that I really liked, I found out at the end of my appointment that my out-of-pocket cost for each appointment would be far too much for me to consider the weekly appointments that my therapist recommended. And that was a super bummer, because she was really great, and I had an amazing first session. In addition to all of this, I am currently prescribed four medications to manage my mental health condition. Let's take a look at what I am estimating my yearly out-of-pocket cost for 2019. I am estimating because it is currently October and I have one more psychiatrist appointment scheduled for the year, which I included in my costs. My medication could change, or I may have to add another appointment. Since there are still variables, this is an estimate.

Psychiatrist Appointments

$236.00 per 15 minute appointment

Went to six appointments in 2019

Total: $1,416.00

Therapy Appointment

$145.00 per 45 minute appointment

Went to one appointment in 2019

Total: $145.00

Medications

Four prescriptions

Medication #1, picked up every three months, $590.32 each three month period, Annual Total $2,361.28

Medication #2, picked up every three months, $248.05 each three month period, Annual Total: $992.20

Medication #3, picked up monthly, $207.03 monthly, Annual Total $2,484.36

Medication #4, picked up as needed, $4.50 each time, Annual Total: $9.00

Medication Total: $5,846.84

Total cost for treatment: $1,561.00

Total cost for medication: $5,846.84

Grand Total: $7,407.84

$7,407.84 in out-of-pocket costs over the course of a year. Well, as long as nothing else happens, changes or I need to add another Psychiatrist appointment. That is a lot of money. That total is crazier than I am.

It's out of control you guys. It should not cost this much or be this hard to get treated for mental health conditions. Your brain is a part of your body. Mental illness occurs in your brain. Mental illness means that your brain is sick, and it should be viewed in the same way as physical illness is viewed. Anything other than that is discrimination in my opinion. It's just shameful. We as a society should be outraged, and we should demand change. If things are this bad now, think about how things will be next year or five years from now. It's not like insurance companies will suddenly become more compassionate, or less greedy. For now I will just have to keep my fingers crossed that things will change for the better, and that I will go through my life receiving the mental health treatments that I need. Things cant keep going on like this.