February 25, 2013

Lost Between the Wallet and the Office Visit

Most of the time, I'm quite happy to be in a job that offers me insurance.  It's not perfect, but it is appreciated.  I mean, I won't have to worry too much about being able to pay for my care if I survive getting hit by a bus.  However, I do still have a beef that I think needs to be discussed.

I'm not shy about telling people that I have been diagnosed with Depression and General Anxiety Disorder.  I've been on multiple medications over the years, even participating in a drug study that helped bring Lexapro to the market in the US.  I've found that the Zoloft I've been taking for the last 5 years or so is starting to be less effective.  I'm not suffering from the sadness or thoughts of self harm that a full blown episode can bring, but I just really don't have the energy to enjoy the company of others like I used to.  So, I've been spending more and more time in my jammies, on the couch, enjoying some solitude.  The thought of being among a crowd of people was really just not appealing; I didn't want to have to be charming or dialed up past a 3 or a 4.  So, I generally opted to stay home.

Now, I know someone will pipe up and say I shouldn't *have* to be "on" to go out.  And you're right.  But, it's so normal for me that people would notice and ask questions.  I didn't have the energy for that either.

Finally, I was just fed up enough to do something.  I decided it was time for a med check.  There are some new drugs on the market.  It might be time to find out of they might work better for me or not.  So, I started with a couple of calls.

First, I reached out to a psychiatrist who boasted flexible hours.  She must have a tiny practice because in order to communicate with her, you *have* to leave a message.  She doesn't have email, and she doesn't have a receptionist.  That delay in talking with a real human being can be discouraging to people in crisis.  I get that's what she needs to make her business work, but it's frustrating to me, knowing I've been there.  So, I left a message and waited.

The second place I called was within walking distance of my apartment, and part of the same network that my primary care physician is in.  Their message on their appointment scheduling line was that you had to have a referral from an in-network doctor, and then they were scheduling out appointments in 4-8 weeks.  If someone is suicidal, or at the end of their rope, they might not be able to do that.  As is, I wasn't willing to wait, and all I wanted was to try a different medication.

I figured since if I ended up seeing a professional at the clinic in my area, I might as well get the referral, so I called my family practice doctor to talk with him.  I told him what I was looking for, and after talking with them, he called in a new prescription for Cymbalta.  I was truly happy that he'd do that for me because I no longer have co-pays.  I'm responsible for a percentage of the total office visit, and I'm told that's generally around $100.  That seems WAY too expensive just to sit and talk to someone when I can do that on the phone.  I thought I was on a roll until I got a message from my pharmacy, saying that they couldn't fulfill my prescription entirely since they needed something more from my insurance.  I could pick up the pills, but my insurance wouldn't cover it yet.  Not having the $300 laying around, it's an easy guess that it's still waiting for me, three days later.

The good news is, I'm not out of the Zoloft, otherwise I might be hurting.  The reason for the delay?  My insurance company has a list of 3-5 front line drugs they want to have people try first, before they'll authorize others.  I went through this when I started on the Zoloft 5 years ago.  You'd think they'd still have that in their files.  (Because you know, crazy people never have their records expunged.  Never know what we'll do.)  So, now my doctor's office has to write them a letter saying that we've tried all their recommended drugs, and we want to try this one now because the others weren't effective.  Delay delay delay.

What's frustrating about this is two-fold.  First, there are so many medications out there that it's nearly impossible to get it right on the first try.  Like I said, I've been on probably 5-6 of them since my 20th birthday.  Some worked a little, some worked not at all, and some of them worked well, but lost their effectiveness over time.  It's frustrating that my insurance company seems to feel that the drugs they've chosen, for whatever reason, are the handful that you've got to try before they'll consider something else.  Brain chemistry is fickle, and none of us are wired the same.  I really wish my carrier would be less of a stickler for what they'll cover out of the chute.  Mental health is a bit like an hourglass, and many people don't start working towards a solution until much of the sand has fallen through the center.  Having to try their preferred meds, or wait for authorization just throws another delay in an already imperfect system.  Because of this, it's very easy for people to give up, especially if they're already feeling a tremendous pull into the blackness of their own head.

To add in a bit more frustration, when I called the pharmacy to confirm that's what was going on, I asked if there was anything I, as the patient, can do.  The technician I spoke to said no, there really wasn't.  I had to wait for the gears to turn.  Again, it's easy to start to feel out of control when this sort of thing happens, and it's another place in the process where those who are just barely holding on could easily let go.

Finally, a few minutes before 5:00, my cell phone rang.  On the other end of the line was the psychiatrist I'd left a message for earlier in the day.  In our short discussion, I learned that in order for me to see her, I'd be responsible for paying up front, and would just have to hope my insurance would reimburse me for part of the costs.  Sometimes they did, sometimes they didn't.  The initial consultation would be upwards of $300, and each visit would be between $90 and $200.  To some degree, I live paycheck to paycheck, like much of America.  I also have no revolving credit, and am not allowed any until my bankruptcy is discharged in three years.  Even then, finding a lender to extend me credit, I imagine, will be difficult.  So, you can imagine my reaction to hearing those figures.  It took me a few moments to get my jaw to work again after picking it up off the floor.   I politely declined her offer to set me up with an appointment, and am hoping that the newly prescribed meds, when I get them, will be all I need.

But, what I took from this is that our mental health care is broken.   I understand checks and balances.  But, I also know what it's like to really need the care, and how easily you can give up when you hit roadblocks.  I think I hit close to 5 just in one day.  If I knew a way to get my claws into making this easier for those who really need it, who can't weather the storm, I would.  I've been there, I know how awful it is, and can only imagine the people who get steamrolled by the challenges.  With the right care, it really does get better.  It's just too bad that the right care seems to be as easy to find as Princess Peach.


  1. You're 100% correct the system is broken. I wonder how many people end up self harming with the built in waits for new medications?

  2. Honestly, even one is too many. This is just one example. I can think of at least 4 other times in my life when I've hit similar brick walls. Thankfully, I'm either too dense or too pig-headed to give up without a fight. But, that's more the exception than the rule. This pains me to know how commonplace this is. I really do wish I had a name of someone with whom I could talk just to see if there's any way to affect some change. So much needs to be done, but any small step forwards is worth celebrating.


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