My name is Sarah B. and I am a survivor of mental illness. Living with mental illness is like riding a roller coaster. Filled with ups and downs, twists and turns, life is filled with uncertainty. Part of the roller coaster ride relates to obtaining, receiving and paying for insurance coverage and services for mental health.
There is the incident of a young man, age 17 who was hospitalized. The doctor recommended psychiatric in-patient care. This young man’s insurance company refused to pay, telling the family to seek outpatient care first. This response from the insurance company was given in spite the Director of the outpatient facility also recommended in-patient hospitalization. Outpatient care was tried and failed. The young man ended up being incarcerated.
Another story is that of a young mother, age 38 who became disabled. She sought health insurance and the premiums were either too expensive or she was denied coverage because of her diagnosis. Eventually she found insurance coverage with out-of-pocket expenses to be $6,000-$8,000 annually. Obtaining insurance coverage did not reduce the problems she encountered, as many health care providers would not accept the coverage. These incidences increased this young mother’s anxiety and depression, causing her more severe symptoms.
I became disabled before the age of 65 and had insurance coverage with my husband’s employer. When that coverage ended, I had to seek supplemental insurance. The first thing I encountered was the cost of premiums which were triple for individuals below age 65 compared to individuals age 65 and older for the same coverage. An example of the budget restraints placed on me is the premium quoted was $350 per month. At that time I had income of $800 per month. The cost of the insurance was approximately 44% of my income. Who can afford that?
Before reaching age 65, I found a policy that combined Medicare and Medicare supplement at a minimum cost. In that plan, the costs for mental health services were covered at 50%. Costs for physical problems did not and do not have this limitation.
Today at age 65, I maintain coverage for Medicare and Medicare supplement. Mental health care is still covered at 50%. Co-pays for mental health services are set higher than physical health services. For example:
Cost of MH visit $70 PCP Visit $167
Co-Pay 40 Co-Pay 15
Co-Pay = 57% MH Visit Co-Pay = 9% PCP Visit
If one compared a PCP visit at the same rate as a MH visit the cost of co-pay is 21% for the PCP visit vs. 57% for the MH visit.
Inequity in coverage for mental health keeps people with mental illness from seeking the treatment they need. Higher costs of insurance deter individuals getting the protection they need. Difference in co-pays cause hardship for those on limited income. A more equitable way would allow those on disability to afford the coverage they need, seek available services at an affordable cost, and reduce hospitalization.
Regarding hospitalization, recall the story of the young man who was denied insurance coverage because the insurance overruled the recommendations of a doctor and Director of an outpatient facility? On February 9, 2006, my doctor referred me to a psychiatric inpatient stay for a minimum of five days. The insurance company I had a policy with denied that stay, allowing only for a 23-hour observation. If this had been a person with diabetes, cancer or heart disease, the denial would not have been made.
Individuals with mental illness are no different than you. They simply are people who have more obstacles to overcome than you.