Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More
As someone who has worked in the area of mental health for many years I can attest to how dismal health insurance is for those with mental, drug abuse and a combination of both problems. I will concede that most health insurance policies cover in patient hospitalizations fairly well. That is important because there is not question that any inpatient hospitalization for a physical or mental illness is exceedingly expensive. Do not get too enthusiastic because if more than one hospitalization occurs within one year the likelihood of insurance coverage diminishes greatly. So, let’s look at health insurance for those coping with emotional problems that range in intensity from paranoid schizophrenia to general anxiety disorders and many problems that fall in between.
It is often said that paranoid schizophrenia and the other chronic psychoses are the "great equalizers." What is meant by this is that this category of mental illness impoverishes every patient it touches. The reason for the resulting impoverishment is that these illnesses can be so very disabling that it is impossible to hold down a job. Simply stated, the symptoms of the psychotic illnesses, such as auditory hallucinations and delusional thinking of all types make it impossible to function in the real world when the symptoms are full blown. Even with modern medications it becomes important to minimize stress and pressure in order to prevent a relapse. In addition, some people still experience hallucinations with the medication but at a lower intensity and the delusional ways of thinking tend to endure despite the medication.
Unless a family is very wealthy, most of those with paranoid schizophrenia or other psychosis eventually must rely on either Medicaid or Medicare through disability under Social Security. While systems vary from state to state it is often possible for someone with a severe and chronic mental illness such as schizophrenia to go on disability and qualify for a small monthly income as well as Medicare and Medicaid insurance coverage. Because Disability comes under Social Security it is usually necessary for an individual patient to have a work history during which some payments were made into the social security system. If they do not have that history they will probably have to apply for Welfare and Medicaid along with food stamps. In the end, most people with acute and chronic mental illnesses are forced to rely on the Welfare system and Medicaid to receive the treatment needed to prevent decompensation and re-hospitalizations.
Those with serious but less debilitating mental illnesses such as depression, phobias, adhd and other psychiatric problems that might require the person to take weeks or months off from work they may qualify for temporary disability provided by their private insurance and place of work.
In most cases people suffer from the types of emotional difficulties that do not prevent them from going to work. However, the nature of their problems often results in less than maximum work effort and productivity. Also, there are often many days of sick leave used because of their depression and anxiety. It is these types of people who rely on their health insurance to pay for visits to the psychiatrist, prescriptions and weekly visits to their psychotherapist. Here is where many problems lie.
Today, health insurance is regulated by a system designed to reduce medical costs. That is why many insurance plans are what are called HMO’s or Health Maintenance Organizations. There are similar types of insurance referred to as PPO’s. There are many variations on these types of health insurance coverage but they are all designed to reduce health costs. The way health costs are kept as low as possible is through a system of permission granted by the HMO for the psychiatric service or by referring to health practitioners who are part of the HMO or PPO health network. With an HMO a patient is required to see only those doctors, social workers and psychologists who are part of the network. With a PPO the patient has a choice of seeing practitioners who are in the network or who are outside of it. However, if the patient chooses a practitioner outside of the network, there is a heavy deductible that must be paid before the insurance will take over. A deductible is what the patient must pay out of pocket before health insurance will take over. In some cases the deductible can be as high as two to five thousand dollars, not a small amount for the average patient.
To complicate things further, HMO’s and PPO’s will pay for only a limited number of visits to the psychiatrist, social worker and psychologist per year and some even have a life time limit. Once you have met your limit you have to pay the bills for psychotherapy and psychiatry by yourself.
My New Year Wish is for everyone to have the type of insurance coverage for psychiatric problems of all kinds that allows them to receive all the treatment they need every year and for as many years as is needed. This may sound expensive but we know that problems such as depression end up costing businesses and the nation millions of dollars each year in absences from work and inefficient worker productivity.
What are your opinions about this issue? Your comments are encouraged.