The Cost Of Mental Health Care for a Semi-insured 23-year-old

In retrospect, I can see that depression first struck me when I was 14: Suddenly, laying in bed doing nothing seemed vastly more appealing than doing any of the things I had loved for years—dance, skiing, even school. My high school Livejournal is filled with my confusion about my unpredictable moods, but I assumed that all teenagers were moody and that everyone felt the same as I did. It wasn’t until I got to college that I realized something might actually be wrong, and it took until I was 20 to get diagnosed as bipolar and put on medication.

I’ve been in various forms of treatment for years now: college counselor; old-school Boston psychiatrist that handed me drugs once a month; confused beach town therapist who had no idea what to do with me; extremely mean suburban therapist; current wonderful resident at a NYC hospital who sees me once a week and functions as both therapist and psychiatrist.While some treatment has been easy to access—namely the college counselor—most required navigating a maze of phone calls, referrals, string-pulling, insurance snafus, and money.

I am very lucky that I am able to access this care at all, and it’s due largely to two factors:  I’m still on my parent’s health insurance in New England, and my mom was a nurse before I was born. Both of these factors have made seeing therapists and psychiatrists relatively easy at home in Massachusetts—Mom set me up with the treatments and our insurance paid. For years, I got my prescriptions from the Boston psychiatrist when I was at home, and saw a counselor at school when I was in NYC. This made my treatment essentially free (besides the copay for my meds and doctor), but ineffective. You want your therapy and meds to work in concert, which is hard when their respective providers are states away.

Eventually, the Boston psychiatrist ran out of ideas of what drugs to give me and suggested I seek another opinion, so my mom called up an old nursing school friend who is now head of psychiatry at a major Boston hospital. This person recommended us the extremely mean therapist, who I hated but went to dutifully two times each week while at home last summer, because I was desperate and out of options and just wanted to not feel like I was dying. My insurance covered one weekly visit, and my wonderful, generous parents paid the other $250 per week out of pockets, hoping that some intensive work before I returned to school in New York could help us plan a long-term strategy. It was also because they were worried that years of depression and anxiety had turned their vibrant daughter into a pet rock who lay in bed until 4 p.m. and then was terrified of getting behind the wheel of a car.

My parents’ health insurance covers me only in New England, except for emergencies, which means that if I break a leg in New York City I’m golden, but if I need therapy I’m fucked. It’s better than nothing, and if I get a UTI or bronchitis I just mosey on down to my college health center. Once I graduate in May this will be ripped away from me and I will be peeing into cups for $140 at the urgent care center (America!). All this means I couldn’t see a therapist at school in New York unless I wanted to be shelling out $300 a session, which I certainly did not. Luckily, by some twist of insurance fate, my prescriptions are covered in NYC. When I was studying abroad in France and attempting to refill prescriptions, I went to the pharmacy and had a meltdown in very bad French when I saw that a month’s worth of Wellbutrin was over 300 euro. The government reimburses you all of that, but I was mid-mental breakdown and pretty sure I didn’t have that much in my bank account.

Ultimately, the extremely mean therapist referred me to Mt. Sinai’s outpatient psychiatry clinic, as she had an in with the director. I wish more than anything I had been hooked up with them years ago instead of seeing college counselors, but so it goes. I also hope it comes across here how important and fucked up it is that you need to know people to get affordable and adequate care: After years of seeing college therapists in New York, who often said I needed more help than they could give me, not one mentioned Mt. Sinai or any similar programs in the city. It took my mom calling in a favor with a college roommate who is now a mental health care bigwig to get the recommendation for the therapist who ultimately knew someone at Mt. Sinai. I am incredibly privileged that my mom knew that bigwig and is also amazing at making phone calls and advocating for me, because I sure as hell could never have figured all that out in a haze of depression. And while there’s a lot of talk about mental health care being accessible and affordable for all, that seems like a pretty distant dream from where I’m sitting.

Here’s how the money works: Mt. Sinai’s clinic operates on a sliding scale. Since I am a full-time student, Mt. Sinai counts me as unemployed, and I pay the unemployment rate of $50 per weekly session. This is a full therapy session plus a conversation about my medications, which are currently in the process of being changed. My doctor and I often spend an hour and a half together, despite the fact that she is a super busy resident who also has other psychiatric patients, ER shifts, and pediatric work. She is a blessing from the universe and I kind of want her to adopt me.

The cost of my mental health care over the past six months:

• Therapy: $1,200
• Medication copays: $300
• Subway to therapy: $120
• Sunglasses to hide subway tears coming home from therapy: $10
Total: $1,630, or $271.67 per month

Lifetime therapy and medication costs plus what my parents pay for health insurance are too disturbing to contemplate, but I’m alive, and typing words on a screen right now, and sometimes I go to parties. As far as I’m concerned, every penny has been worth it.



Jessie Lochrie is a Boston-born, Brooklyn-based writer who is probably popping a Zoloft even as you read this.


24 Comments / Post A Comment

sea ermine (#122)

Can we talk about how hard it is to find a therapist that takes insurance, let alone your insurance? Everywhere I call says they wont take insurance but have a sliding scale, and generally the lowest they go is $50 (and you have to be unemployed or near employed to get that rate) and often it’s more like $60-80. I really can’t do more than a $20 copay though! Is there a reason why therapists are so resistant to dealing with insurance?

cordovan sofa (#6,125)

@sea ermine As I understand it, it’s a confluence of three factors. (1) It’s still fairly recent for most insurers to cover mental illness, and they’re cagey about what they do or don’t cover. It hasn’t become “normal” enough yet for it to be a regular thing therapists figure they need to do. (2) Dealing with insurance billing is a major hassle that becomes a person’s full-time job. Witness how GPs are scrambling to join joint practices; you do not have the time to deal with insurers AND provide medical treatment. You need a billing department. Most therapists still work in individual, not shared, practices. (3) As soon as an insurer is involved, there’s a lot of required reporting. This not only takes time, but violates a lot of therapists’ ideas of the degree to which it’s ethical to share information about what a patient has disclosed to them.

squishycat (#3,000)

@sea ermine I don’t think I’ve ever had a therapist who actually took insurance, mostly because nearly every one I’ve seen has had an independent practice and thus in no way has time to deal with insurance BS (I was temporarily a receptionist in a medical office and did some of the billing – oh my god). I’ve never had a problem getting my insurance to pony up after the fact, but needing to have the money to pay directly is definitely the difficult part.

laluchita (#2,195)

THIS! OMG this! Finding a therapist who takes your insurance is basically impossible, ESPECIALLY when you are already depressed and calling one therapist and finding out it won’t work is a monumental effort. UGH. I am currently spending about $40 a week on acupuncture and herbs for other things but also depression and anxiety and the idea of a) finding a therapist and b) paying for it and c) finding the time and money to do both of those things is more than i can deal with right now.

Meaghano (#529)

@laluchita I know. I always say I need therapy to find a therapist.

Christy (#3,892)

Here’s what I did to find a therapist who takes my insurance: I looked it up in the insurance’s guide. So I went to the BCBS website and found the therapists in my area that they cover, and basically went down the list. I’m a federal employee, though, so IDK if our health insurance interfaces are different.

@Christy some interfaces also have an email function — I think Psychology Today’s website has a directory, with an “email” button. So if you’re not sure, you can email blast a dozen or so therapists about the insurance thing. Super stressful/time consuming to do on the phone.

sea ermine (#122)

@Christy I did that but everyone I called (out of like 20-30 people) said they either don’t actually take my insurance or the therapy they provide is not what I’m looking for (like people who only give therapy to children or only for people with aspergers or something other than just general CBT). It was mostly people who just didn’t take my insurance, and I’ve called my insurance company about it but can’t get them to update anything.

I am not a federal employee and I have private health insurance through my company. It’s possible the marketplace plans/government plans are better (I know my dad is a government employee and he’s never had an issue with his health insurance)?

I’ve definitely being doing the email thing with Psychology today but everyone just wants to do a no insurance sliding scale, which is super weird because I have never ever had a hard time getting a regular doctor to take my insurance.

Allison (#4,509)

@Christy I was trying to help a friend find a psychiatrist this way and apparently every suggestion I had, she’d tried and they were all lies. No one was accepting new out patient clients at an entire hospital. It is crazy to me that it is so difficult.

@sea ermine booo! I actually solved the $ problem by seeing a student at UPenn, which, mercifully, fit my needs for therapy and my budget (which involves splitting costs w my parents, I am 23) at $40/session.

azile (#6,014)

@Shan Palus@facebook This is so important!! I am a student therapist (psychologist-to-be), so I have a bias. That said, I think that students, along with being affordable, are often actually good therapists because their newness to the field means they’re so invested in each client. I have people I see for $5 or $10 an hour, we don’t ask that anyone prove need, and we work hard. I personally live in a city you’ve probably heard of but never visited… but for anyone looking for a therapist, check your local universities.

notpollyanna (#2,841)

This is such a big problem. Even with good insurance, I have had so much trouble. A lot of the problem was that I had a lot of bad treatment before I found a psychologist and a psychiatrist who worked for me, liked me, actually helped me improve, and didn’t make me sicker. It took ten years. If I found them sooner I might have started improving sooner instead of getting sicker and sicker for those ten years. It wasn’t finding people who took my insurance that was so much the problem, it was finding people who wouldn’t psychologically abuse me in “treatment”. (Intentional? Bad luck? I’m a massive jerk? I don’t know, but it happened and it sucked and I’m glad most people don’t have to deal with that.)

There is so much energy required in navigating this that it is nearly impossible for someone who can’t get herself out of bed to eat. Having done this, I always advise/offer that the person have someone to advocate for them: make appointments, deal with insurance, be a sounding board to judge whether therapy feels bad because it is working or because it is not working, whatever they need.

When I was working and paying for everything on my own, it was ~$400/month for me out of pocket after insurance for a psychologist, psychiatrist, dietitian (eating disorder), and medication. I was making $25k a year, so that was almost a third of my take home pay. I was living with my parents (not good for my mental health) and had massive student loan debt I was also paying.

echolikebells (#3,272)

I have decent insurance, and still have so many issues and expenses in this. It’s terrible. I was paying $100 a visit (AFTER insurance) for a terrible therapist for a couple months. I work for a university with a medical center under its umbrella, so therapy is free/low cost if you get in to their therapists, but it is expensive if you go elsewhere. And their therapists are never accepting new patients, even with referrals.

Finally I confessed to my GP that I hated my therapist and that I couldn’t go anymore, especially since the money was just adding to the stress. She closed the door, said she liked me and wanted me to be better, and that she’d call the psychologist that she’d done her psych residency under and ask her to take me on as a patient as a favor. Thankfully she did, and now my visits are free (I think? unless I get a weird bill soon, but it hasn’t cost me anything yet) and I love my therapist, but if I hadn’t known someone or had someone willing to advocate for me, I’d never be in the position I’m in now.

jessieflux (#4,400)

@echolikebells that last bit is WILD. your GP sounds like a saint.

My insurance, in theory, pays for 100% of my therapy, but I have to pay out of pocket and then they reimburse me. I haven’t done that process yet because my therapist only puts together the paperwork once a month and I haven’t been seeing her that long yet, but I’m a little bit afraid it’s going to take like, 6 months to get my money back. I can afford it now but not for that long!

automaticdoor (#145)

Oooooh, ask me! I am a little older than you and I spend *well* over 10% of my AGI (this % sticks out to me because of itemizing deductions, which I considered this year) on medication, psychiatrist’s visits, lab work, unreimbursed health insurance and other assorted costs for my bipolar disorder, and I’m an okay-paid health care policy person (haha, I knowwww, health care, the irony) in DC.

Costs: My psychiatrist doesn’t take insurance, so that’s $200/month (I see him once a month, so $200 per visit) alone just to get meds and talk to someone for half an hour. My fancy-ass platinum Obamacare plan (because I’m working for a small business, I don’t have employer insurance) has lowered my medication co-pays though raised my insurance bill slightly but now my generics are free (so the moral is, work out all the costs in advance because a cheaper plan would have meant I’d be spending hundreds more a month). Cost: $360/month, reimbursed half by my employer (but that’s taxable, thanks new regs). So for all my Rx meds, I’m down to $70/month starting in January. Before Obamacare, my bipolar disorder was an excluded condition from my health insurance, so none of the lab tests were covered at all. I’m still paying off a couple of panels from a year or two ago when I was an unemployed grad. (By the way, payment plans are yay! Call the lab people, everyone. They’d love to work it out with you.)

I can’t even imagine what I’d be paying if I needed active therapy–nothing super-good around here is also covered by insurance.

So, the moral of my story is, you probably can do it on your own one day if I can! I even manage to pay my other bills and have brunches with my friends and stuff. I believe in you.

jessieflux (#4,400)

@automaticdoor all hail obamacare! and it sounds like you’ve got a pretty good system going. i realized when i read this comment that i didn’t include labs in my tally, but for some reason my insurance covers my bloodwork? or my doctor talked them into it? i’m not sure but i’m not asking questions!

automaticdoor (#145)

@jessieflux Well, and I realize my costs would skyrocket if I needed weekly or twice-weekly therapy, so there’s that. Or if, as in some periods, I needed to see my psychiatrist more than once a month. So, this is one version of what being stable and bipolar costs in DC. The most amazing thing, frankly, is that I’ve managed to keep all of this entirely secret from my employer. My boss only knows I have a “chronic condition” that caused me to be turned down THREE TIMES for health insurance before the one plan took me (and excluded bipolar, the one condition I super needed it for). He just assumes it’s related to my migraines. (I let him assume–we’re too small to be covered by the ADA, so I would rather him not know.)

pandaonaplane (#1,528)

Here’s a tip that helped me out, find and LCSW in your area. LCSWs are Licenced Clinical Social Workers that provide clinical therapy and are usually far less booked than psychologists and most take insurance. Even if the LCSW can’t provide you with the level of therapy that you require, they usually have connective resources to get you to the therapist can help you. They may even be able to get you in with that super booked not taking new clients until the next decade psychologist you initially contacted.

pandaonaplane (#1,528)

@pandaonaplane Also, something else that helped me found a good therapist was considering the time of year I was searching. I know a lot of situations cannot wait but if you are not in crisis and seeking general counseling this can help. I live in a college town and was nearly laughed off the phone when I called in October (homesickness and mid term stress seem to cause a lot of mental health issues). When I tried my search again in February, I had 2 doctors call me back in less than aday saying they would take me a new patient.

laluchita (#2,195)

@pandaonaplane I have also found in my experience that LCSW’s often have better politics, and are more willing to talk about issues of race/class/gender etc which definitely impact my mental health. Although that could just be the LCSWs that I’ve seen, I’ve definitely seen like 15 mental health professionals over the course of my life, and the best ones have all been social workers.

pandaonaplane (#1,528)

@laluchita AGREED. I am also very anti medication (for myself, I’ve seen it do wonders for others) and I have never had an LCSW mention medication but I have had a couple or psychologists insist that I meet with a psychiatrist immediately to get a script for anti-depressants.

Laurabean (#3,040)

@laluchita 100% in agreement.

oldflame (#1,553)

I totally feel this. I’ve been hopping between GPs at health clinics as I’ve moved around to get my prescriptions filled, but I haven’t seen a therapist in three years, mostly for the reasons everybody else has brought up.

What’s a depressed person to do if they get up the courage to phone some psychiatrists and get an appointment and are able to pay for it… and the psychiatrist is terrible? I did that whole thing three years ago, gave up of finding another one, moved, and now I’m thinking of starting the struggle again. Hopefully I’ll have better luck this time.

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