In the saga that is my mental health and working with my health insurance, I have some good news to report: My insurance company approved my new anti-depressant, and they paid the copay for the new medicine (because there is no generic version of this particular pill yet) and they approved and paid for my DNA swab test to see which medicines work best for me (in the tune of $5,000, which they negotiated down to $1000, $100 of which I’m responsible for.) So, they paid for most of this. Which leads me to questioning this absurd system we have.
I reside snuggly in the middle-class. In fact, by some accounts I’m considered “upper middle class” which boggles my damn mind. Like, what?! We are a one-income family, with the majority of our health insurance premiums covered by my husband’s company. We pay premiums, and they are too expensive if you ask me, still, when we get sick and go to the doctor our co-pay is rarely over $30, that includes my mental health co-pay. I see my therapist two times a month, and my mental health nurse practitioner once a month. Which means I’m spending $90 a month just to “see” people. Still, I feel like I can’t complain, because some people who desperately need to have the sort of help I get, simply can’t afford it or they don’t have access to it. See Veterans and the working class.
Enter my new pill: Trintellix. It’s a revamp of an older pill, and has yet to be made available through a generic prescription. I won’t pretend to know why that is, but my suspicion leads me to think that they like to milk the market dry before they “invent” an alternative. But that’s not the point. The point is that I received a letter from my insurance company telling me that I’d been approved for a one-month supply and they had graciously picked up the $500 price tag for the new pill. I was excited, because I’ve been on samples for three weeks now and they seem to be working well. So I went to the pharmacy to have them fill it. That’s when they told me I still owed $80 out of pocket. Ho hum.
But wait! There’s more! The pharmacist told me that I could use this little card that the doctor gave me and it “might” save me more. So I sat on the phone at the CVS in Target (you didn’t think I get my prescriptions filled anywhere else, did you?) and finagled this card thing with these lovely people at Trintellix. All in all it wasn’t too hard, and they really were nice and helpful, even after I’d put my birthday in wrong and had to call back. But that isn’t the point either.
Ahhhh. I’m tired by now right? This has been a one month ordeal. Waiting on four different groups of people (therapist, insurance, CVS, Trintellix) to work together to get me these damn pills. Meanwhile, I’m running out of samples. Meanwhile, I’ve weaned off my Lexapro. Meanwhile, meanwhile, meanwhile.
This is a small, very small snippet of the healthcare racket that we have here in this country. Very small. Now I won’t completely downgrade it, because it is mental health and mental health is very important, but I can’t imagine what people with diseases like cancer or AIDS or persistent heart problems go through. It’s got to be nuts. Meanwhile, we want to talk a mad game about mental healthcare, and making it affordable and easy to get, but then we get jacked around like this. I’m persistent. And I know my rights. And I don’t care if something costs $20,000, I’m going to ask my insurance to pay for it, but some people aren’t like me. They won’t self-advocate. And then what?
All I’m saying is, I think the cost, the hassle, the stigma, and the accessibility are totally screwing people who need good, quality mental health care. Who need answers. Who just want to know there is help out there. There are people who don’t have insurance and still need mental health care. There are people who have insurance, but can’t afford the co-pay to get mental health care. And that’s just one aspect of their overall health. We have to change things, y’all. We have to.
Anyway, thanks for reading my story today. Thanks for supporting those of us with mental health issues. Thanks for talking about it, accepting it, helping us when you can. It’s really important that we have people in our lives who care and who listen. Because for some, they aren’t getting it anywhere else.
Take care of yourself first. Then others.