I’m trying to take care of my mental health, I swear. Insurance, however, is a hindrance more than a help.
For those of you who are new, I’m Bipolar II. My current regimen was working well before this pandemic. Now it feels like the meds’ efficacy is being strained.
I asked my primary care provider to represcribe the low dose of Abilify I’d been on up until a few months ago. (Yes, I took myself off it without a psychiatrist. It was a very low dose, and I knew what a battle it’d be to find a psychiatrist. So I just carefully monitored symptoms, and as suspected, I was fine.) Unfortunately, adding the Abilify back doesn’t seem to have made a difference. I’m still pretty emotionally brittle.
Neither myself nor my PCP are comfortable having him tinker with dosages or put me on a different drug. So I had to set about finding a psychiatrist.
First things first
Before I saw a psychiatrist, I wanted to investigate a drug I’d been given samples of in the past (Rexulti) that I was interested in maybe trying again. I wanted to know whether that was feasible financially before asking a psychiatrist about it.
I hadn’t gone on it for good the first time around because my insurance wouldn’t cover it until I’d tried at least one other generic drug. (Insurance companies are all class, I tell ya.) The Abilify worked fine at the time, so I just stayed on it and didn’t pursue the Rexulti.
But turns out it would’ve been moot anyway. Because when I called this time around, I found out my copay would be 27%. The drug is $1,300ish a month, so my copay would be about $350 a month.
(Before you ask, yes I checked GoodRx since I’ve had good luck with it in the past. It’s $1,200ish through that.)
So… $350 a month? Um, no. It wasn’t that amazing a medication.
Disheartened, I turned to finding a psychiatrist who would hopefully have another suggestion (or who would just increase the Abilify dosage). And that’s when the frustration began.
I went online to the provider search engine and chose Mental Health NP and later Psychiatrist. I went through at least 60 results between the two.
One practice with a variety of locations comprised more than half of the results, but it didn’t accept my insurance as of this year. One practice was only for kids on Medicaid. One’s phone number was out of service and I couldn’t find any listing on the Internet, so I assume the practice dissolved. Some listings were for in-patient treatment (at least one was for in-patient addiction treatment). One was for pain management. One had a single psychiatrist on staff that took my plan; he was in Mesa (about 30 miles away) and not available until August. One result was for a radiologist.
I also called Banner — a hospital system here — and they couldn’t find a record of the doctor my insurance listed. But they did forward me to the psychiatric department. There, a woman told me that she wasn’t allowed to schedule any more appointments until early May.
To be clear, she wasn’t saying the first appointments were in early May. No, she couldn’t start scheduling until May. (It was early April at this point.) Oh, and it wasn’t clear to her whether, once they did start scheduling, they’d be taking new patients.
I took down her name and number and said I’d call if I didn’t find anyone else. Sigh.
Success! Or not.
Finally I found one place relatively close to me, accepting new patients in a timely manner. Problem: It required a walk-in appointment. Uh, what?
Yep, they wouldn’t schedule a first appointment. You had to walk in between 8-12 on Monday or Tuesday morning at one location or 8-12 on Friday morning at their other one.
I woke up early one Monday and caught up on emails. I went over there, deciding that I’d see how long the wait would be, which would determine whether I could stick around long enough to get seen.
When I got there, I discovered it was a community health center. Not good.
Talking to the receptionist, I found out that the first walk-in appointment was to see a doctor who would then pass me along to a psychiatrist. Who wasn’t even there on walk-in days.
None of this was communicated to me over the phone — and I was very clear that I was looking to see a psychiatrist when I called.
This whole setup was a no-go because I’d have had to switch my primary care provider to the center in order to have my visit covered. And I have no interest in doing that since not many doctors will prescribe me energy medication the way my current PCP does.
So I waited a couple more weeks until it was early May, then called Banner. They’re now not even (maybe) accepting new patients until early June. *Bangs head on wall*
So I got back on my insurance’s search engine and checked out psychiatric nurses, this time I discovered the Behavioral Health section where I’d been using the Specialist one.
Once again, at least half of the results were for the company that no longer works with my insurance. Other highlights included multiple providers who also no longer take my insurance, one who only sees patients in facilities, a nurse who doesn’t take insurance at all and one who retired back in November.
At this point, I’ve gone through more than 100 results among the various psychiatric categories in the search engine. I’ve made at least 30 calls. And I was no closer to finding a prescriber.
So the full name of my insurance is Allwell by Arizona Complete Health. I’ve been asking about Allwell, but one of the women I talked to — who had me send a pic of my insurance card so she could check whether I was covered — specifically called it Arizona Complete Health.
I started wondering if that’s the name I should’ve been using instead. So I called up a new search and started calling. Again.
In the 79 results I went through, there were ones for radiologists and anesthesiologists sprinkled in. Several others only accepted the state Medicaid program by Arizona Complete Health. One practice had only one provider who accepts my plan and that person is apparently at capacity patient-wise. One result literally had “DO NOT USE” before the practice’s name. Others were Banner or the chain that didn’t accept my plan anymore.
Then I finally struck gold! One place — about halfway through the list — had been relatively sure they took it but had to check and call me back. That same afternoon I got the call: They did take my insurance. Yes, they were sure. Yes, specifically Allwell. (I wanted to be very clear, so I asked a couple of times.) And they were accepting new patients!
So I have an appointment for the day this post goes up.
I want to talk to the shrink about two aspects of my current emotionally brittleness.
First of all, I want to discuss Buspar, the only anti-anxiety med on the market right now that isn’t habit-forming. Even in better times, I deal with a lot of anxiety, and as you can imagine it’s far, far worse during this pandemic.
I’d love to have a quiet brain not constantly imagining the worst possible scenarios. Like slipping on the tile floor and landing so that my arm or even front teeth crack. (I’ve slipped once and I landed on my butt so I have no idea why these scenarios run through my head. But they’re exhausting.)
Or constantly imagining a car crash while driving, even when I’m far away from the car in front of me. (Admittedly, I did have an accident about a year ago, but since then I keep a lot of distance between me and the next car and still constantly picture the car wrecking or breaking down.)
Or just generally being full of anxiety and unable to sit still very well.
I suspect I’ll have to go off the drug I’m currently on to help me sleep, as it’s a benzo. But if I have less anxiety overall, arguably I would sleep better overall. So I figure it should even out.
Unsurprisingly, I’m very emotionally fragile right now.
I tear up whenever I think about how long this pandemic is going to go on, when I think of the lives lost or sometimes just seeing stupid commercials that talk about all being in this together.
And yes that’s a somewhat sane response to the awfulness going on, but if I’m this fragile right now, I’m worried about how it’ll be once Mom leaves. (Mom leaving is another thing that makes me tear up.)
She can’t stay here forever, but I don’t do well in isolation. Heck, by day four in isolation I was feeling generally hopeless and weeping sporadically.
So I’m definitely going to need someone monitoring my medication, someone I can go to if the depression proves overwhelming in isolation.
But of course, we can’t rely on medication alone. In addition to a psychiatrist, I’m still seeing my therapist. He and I set up a plan. Specifically, we decided that I’d probably do okay if I had at least two visual interactions with people a week.
I have a weekly Zoom chat/game night with my trivia group, so that’s one. We agreed that Mom and I would FaceTime any time I call her. And I have a friend or two who’ll FaceTime if I request it. And my cousin — who I always mean to keep in better touch with anyway — said she’d be game too.
And I’m keeping an eye on MeetUp for any virtual events. Plus someone from FinCon is doing some virtual hangouts, apparently. I told her to give me a heads up the next time, especially since I have a few party games downloaded we can play.
Also, some of my friends and I have discussed socially distant hangouts. That is, six feet apart (probably still wearing masks) and outdoors, since there’s apparently some evidence that the coronavirus is less transmissible outside. It wouldn’t be quite the same as normal, of course, but at least we’d actually be around one another in person.
I have at least one friend who would let me come over pretty much any time I need to. I just have to be careful about keeping that six-foot distance and/or wear a mask because I’m not sure how strict he’ll be about that. But hey, he has a pool, and it should be easy enough to keep six feet apart in a pool while we chat.
But any in-person interaction will definitely wait until I don’t have a 62-year-old asthmatic in the house. Just in case. Besides, that’s really when I’ll need it most anyway.
Finally, if I start to spiral while alone, my therapist told me to change my environment. Even just going for a drive could get me out of my head, he said.
And of course, we arranged it so I now see him every two weeks (instead of the three weeks we had previously). He also said to contact him if I need help in between sessions and he’d do his best to find a time for me. Hopefully, those tele-sessions will help keep me thinking rationally.
But some extra meds wouldn’t hurt either, right? I’ll keep everyone posted.
Anyone else have trouble getting the mental health care they need?