The Truth
Mental health is really important right? Duh! Everyone knows that because it seems to be all people talk about right now. But no one, no one is talking about something even more important. Before you get ready to skewer me, hear me out. I like skewers, who doesn’t? Chicken and bell pepper skewers are my favorite! Access to mental health care. Specifically, finding the medication you need, medication you can afford, and that buddy you call a psychologist.
The Challenge
Okay, they’re not actually your buddy. But wouldn’t it be cool if they were? Then, you wouldn’t have to try so damn hard to find one. It is almost impossible. I am not just talking about any therapist. But finding one that is a good fit for you. Finding one that is affordable. Finding one that takes insurance. Finding one that works with your particular challenge areas and mental illnesses. Finding one in-person. Finding medication that works for you, with minimal side effects, and is actually covered.
Yes, that’s when it gets incredibly hard.
Why?
Why is it so hard to find help? Because we as a country are not doing enough to invest in mental health care. There needs to be more money invested in psychiatric medication, psychological research, training, pay, and benefits for these providers who have helped us survive and somewhat manage throughout this pandemic. It needs to be a priority for our government. But also, insurance companies need to change. They can’t just take the easy way out.
Insurance Company Tricks
How do they take the easy way out? I’m glad you asked.
Off-Label Treatment
Did you know that even if a drug is FDA approved, the insurance company may not cover it for you? That’s because a lot of drugs have their officially approved treatment purpose, but then doctors realize “oh wait, hey that drug that treats acne can also help in treating depression.” Guess what? That’s called an off-label treatment and the insurance company can choose not to cover it because it’s not “approved”. Because they want to make more money. They don’t care that the science is valid. They don’t care that a single drug could have multiple beneficial purposes for society as a whole.
Brand Name Drugs
Did you also know that they will not cover many new brand name drugs, even if they are FDA approved? That’s because, again, the drugs work, but they only want to cover the generic option. If the drug is new and its patent from the manufacturing company hasn’t expired, it’s too expensive for them. So sorry, it may be a revolutionary treatment that is a game changer. But it won’t change your game, at least not until the patent expires, which could be 10 years. You’re playing a game that’s run by the insurance company. In other words, you’ve just been played.
Dosage Acrobatics
Okay your medication is actually covered and it works for you. You're one of the lucky ones. But then, you need to make sure that your dosage is covered. Yes, they actually do not cover certain dosages. If you need 100mg tablets but 2.5 tablets of 40mg is cheaper, you'll be breaking a tablet in half daily. There's also a limit on the quantity they cover as well as the frequency.
Wait, it gets better. Let’s say you finally find medication that aides you in processing your trauma and it’s magically covered by your insurance company. Now, you need someone to help you actually process the trauma. That’s where the therapist comes in.
The Dry Well that is In-Network
Did you know that a lot of therapists are not in-network? That’s because most insurance companies want to pay them dog shit (sorry that was mean, I meant very little money) even though they have the years of education, scientific knowledge, and experience needed to help you. So instead of dealing with a low payout for their services, tedious processing, paperwork, bureaucratic processes, and waiting a long time to be paid, they charge you, the client, directly. The issue is that most of us can’t afford therapy at $250-$400 an hour. That’s why we got insurance in the first place right?
Old Information
Let’s say you magically find a therapist that takes your insurance. You’re so excited because the insurance actually has thousands of people that take your insurance, are accepting new patients, and are listed on the insurance company’s website. Actually, sorry, a majority of those people will not take your insurance. The insurance companies do a poor job (on purpose) of updating their provider list, so they can claim more providers covered, aka better coverage benefits. So even if it’s been 5 years since that provider accepted your insurance, they will be listed. And you will only find out when you call them.
Room for New Patients?
Let’s say they take your insurance, great! But guess what? They may not have availability for new patients. Again, that information is not up to date on most websites. Why? Sometimes it is the fault of the insurance company, sometimes the fault of websites that give you “easy access” to schedule appointments, sometimes the fault of the providers themselves. It’s a lot of people not doing their job.
The Fine Print: Session Limits, Types of Therapy, & Copays
So you’re a genius and you have actually found a provider who is accepting your insurance and is accepting new patients! Because only geniuses deserve mental health treatment right? Problem solved right? No. Because insurance companies limit the number of sessions you can have in a week, have in total, and the type of therapy covered. Yes, you can only heal through somatic therapy but they won’t cover that sort of treatment. Only treatment that they want to cover. Or it’s covered but the copay is obnoxiously high. Yes, it’s possible you may pay a copay as high as $35! Not bad per session, but it adds up over time, especially when it’s on top of your insurance premium.
The Solution!
So then, what do you do? All hope is not lost. A myriad of mental health startups has come to the rescue. These companies, I can't name names because I'll probably be sued, but I'm sure you know who they are, use a subscription model. You pay a monthly fee where you get access to therapists and psychiatrists online. The issue is, despite them being significantly cheaper than paying out of pocket for traditional in-person services, they still cost around $200-$300 a month.
Let's say you're well-off enough to afford that, you're still not getting the help you need. Because a lot of these companies are designed to get you in the door, but then, they don't care what happens. They don't have controls in place to ensure you're receiving the right medication at the right limit for the right reasons. If you have challenges with drug abuse, they're not watching out for that. They're also not as responsive as you'd like them to be, because the providers are probably taking on more clients than they can handle while being underpaid. Then, let's remember that online therapy may not be for everyone. Some people need the social support that only in-person offers. So when you have an emergency and you try to reach your provider, you're left holding the bag of shitty drugs on your own.
So yes, this is why, it’s so hard to find help.
But don’t worry, I didn’t bring you here to only talk about how terrible insurance companies are. Soon, I’ll add an article on how to navigate this minefield to find the help you need.
Sarathimeyyappan Sakthivel is the CEO & Founder of Nirvana Works, the path to happiness and connection.
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