NB: I am writing this primarily for people who are not familiar with the American medical and insurance systems, whether because they are generally well (lucky you!) or from elsewhere. I am not looking for advice about how to handle this better, either with my insurance or with complementary and alternative medicine.

I have great insurance. Let’s start there.

My insurance comes through my husband, and we have it for life. Our premiums are quite low, and there is a no-premium version of the plan. We have good pharmaceutical coverage and the insurance company is diligent about trying to offer me additional help to save them money make things easier.

I have depression. It’s probably genetic. Life stress can make it worse. I spent the six weeks between Litha and Lunasa in and out of the ER, hospital, and more doctor’s offices than I can count because of an unrelated non-psychiatric disease. That’s stressful. My depression got somewhat worse. I got some short-term psych help when needed, and waited to have my regularly scheduled meds appointment (since I know the practice is very busy and doesn’t really have urgent appointments available).

At that appointment I was informed that the practice was very sorry, but they are no longer accepting my insurance. I can continue to see the same caregiver and pay $100 out of pocket for each 15-20 minute appointment whether anything is wrong or not. The caregiver was very sorry to hear about my recent stresses, was impressed with the way I was coping, and sent me on my way, signing off on a change that one of the short-term people made to my meds.

I have to get a new psychiatrist. Here’s what that process looks like for me:

  • Step zero: hope that nothing goes seriously wrong during the following.
  • Step one: Canvass my friends, relations, mycelia, and other providers to see if they know of a doctor they like. See if that doctor is on my insurance. Alternatively, take the list of doctors provided by my insurance and throw darts to pick a name at random. Hope that one of these doctors is less than an hour away by car.
  • Step two: Schedule an appointment with my primary care manager (PCM).
  • Step three: Wait 2-3 weeks for non-urgent appointment.
  • Step four: Drive an hour one way to PCM appointment. Ask the PCM to refer me to psych services through the doc of my (possibly random) choice.
  • Step five: Wait until insurance approves the referral, approximately two weeks for non-urgent referral, plus time for the letter to arrive in the mail, unless I want to call the referrals line every day to ask if it’s been processed yet (extra week of waiting vs spending a 15-20 minutes on a phone call every day for a week).
  • Step six: Schedule an appointment with the psych doc. Wait until her or his practice has an open “new patient” appointment, which could be up to six weeks, if they’re still accepting new patients at all. (If not, do not pass go, return to step 1.)
  • Step seven: Hope that I like the doc when I meet with her or him, that she comprehends my current situation, that she agrees with my current treatment plan, and that she will continue to give me the same meds. If not, do not pass go, return to step 1, or take an alternate side trip on the Medication Merry Go Round of Doom.

This is really good insurance. Seriously.

Just to add to the situation, I have figured out that the change to my meds that the short-term treatment people put in place is actually making me worse, so we have failed step zero. I now have to cope with that fact with minimal relevant specialist support. I am capable of doing that, but not everyone is.

Keep in mind that this is happening to me while my psych issues actively need close monitoring and treatment. I’m responsible for completing all the steps above correctly. Nobody else can do these things for me. If I screw up, either I don’t get a doctor, or it costs me a lot of money, at a time when my work schedule is significantly reduced by….you guessed it, the disease that I need treatment for. Adding financial concerns to my load is not going to improve my depression, to put it mildly.

This is only one specialist service. I have to do this for each and every specialist service that I see. Even when one specialist refers me to another specialist, I have to go to my PCM to start this process. If I’m very, very lucky they will decide that some of those things are urgent, which will cut the wait times from 2-3 weeks to 2-3 days at each step. Except that the specialist might not have any free appointments regardless.

This is the American insurance-driven medical system: SNAFU.

NB 2: Before you comment, please note!

None of this has to do with Obamacare. This insurance is exactly the same as it was before the Affordable Care Act went into place, and for what it’s worth I am a big supporter of nearly every facet of the ACA. I also do not want to hear your theories about how Big Pharma is run by reptilian aliens from Vega and that’s why the medical system sucks, and I should just meditate anyway. Comments that I deem irrelevant or annoying will be deleted without apology both here and on Facebook.

2 thoughts on “American medical SNAFU

  1. As clear and concise a description of the system as I have seen. I wish I could say this was new to me, but I live in the UnitedStates and have too many friends and acquaintances doing some variant of this dance, some have insurance good or bad, some go through social services and some go without a net at all. I can only wish you find the shortest pahn through the maze to your new doctor.

  2. I too have been through the labyrinthine maze that is American for-profit insurance to treat a mood disorder. I hope you find a doctor who is responsive to your needs first time out of the gate and without the 6-12 week wait time for an appointment. Also bravo to preemptively shutting down the anti-med contingent. Good luck and thank you for posting this.

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