Why is it So Hard Getting Approval For Mental Health Treatment?

I finally found someone who I can work with and I am told that my insurance will not cover the visits.

So I left him and found a counselor that was covered under my plan. After 4 or 5 visits, it was clear that we were not meshing. Well, I certainly felt that way. We did talk for 45 minutes at each session, but talking about my days seemed to be all I was doing. And I did not come away from the sessions with many new insights.

This may be a bit overdramatic, but I felt I was not getting anything out of the time in the office. On top of that, I had to invest 40 minutes to drive to the office, and then another 40 minutes or so to drive home after the appointment.

So I spoke with XXX again, because we had worked through issues and I always left feeling we had accomplished something.

He mentioned that in addition to his tenure at Region 10, he worked with clients in the evening through an online company. He was able to get me in if I could work out the details with my insurance company.

27 months ago, the insurance I had did not cover anything related to mental health.

It was a money pit, with no ROI. The money went in, and nothing came out. So I was paying out of pocket for the entire cost of each session. When I went back to work, my company insurance kicked in again. I now have access to excellent coverage for all physical maladies. This coverage has provided peace of mind for any physical concern.

However, even with great insurance, coverage related to mental health issues was and is complicated.

There is a dedicated support staff who works with mental health issues. I get that. I have a separate insurance card for medical and for dental. My eye care is separated from my prescription options. Yet when I want to schedule my annual physical or a specialist appointment to discuss tinnitus (ringing in my ears), I am not required to answer the BIG THREE QUESTIONS. Well, that’s what the intake counselor called them as we spoke yesterday.

• Are you considering harming yourself or others?
• Is your called related to elder, or child abuse?
• I was so shocked, I do not remember what the third question was

But you can be sure I had to answer it with the correct response before we could proceed.

Am I being over-sensitive? Somehow I do not think so. There are not screening questions for me to gain access or approval for an annual physical. But there is an entire sub-structure set up to do what? To “ensure I do not get approval for mental health treatment unless it is processed in a way that attaches a stigma to it?”

Here are my e-mails related to getting back to the counselor I was getting help from.

March 31, 2021, 10:34 PM

XXXX,
I received a call this afternoon from our XXXXX Care Network. They told me that you and they have worked something out and that I can work with you. They gave me this EAP reference # 93-XXXX. I am to call them back after we work out an appointment time. Thank you for getting this going, Joel

April 1, 2021, 11:17 AM

Joel:

That is great news.  I will reach out to our team and let them know of us trying to schedule an intake with each other.  I will also look at my schedule and come up with a couple of days that I can send out to them to let them know to schedule your intake.

XXXX

Here is the Thriveworks email address:  XXXXX@thriveworks.com

The next day I called to get my account set up for my first counseling session. It started out fine and was what I had expected.

But then the conversation hit the skids and careened into a ditch.

You want me to pay how much for each session? No, it cannot be. I should be getting six sessions at no cost to myself, then if we continue there will be a co-pay. But $40 dollars a visit just because thats what you charge, seems over the top to me. I’m going to need some time to think about this. $40 is a lot of money for each visit, when I was expecting zero dollars, at least for the first six visits. I’m going to hang up and get back to you on this.

So now it is FIVE MONTHS LATER

Sep 1, 2021, 10:09 AM (2 days ago)

XXXX:

When I called and began to set up my account, I learned that I was responsible for a $40 co-pay. Immediately, my depression helped me decide that this was an injustice and I should not go any further. So I told the young lady I would get back to her. And as you can see, I did not. Four months later, I am still dodging responsibility for my actions and am no closer to resolving some of the issues that keep me from having close relationships with people.

This, not surprisingly, includes the relationship with my wife.

My wife reminded me this morning that she pays $150 out of pocket each week for her therapist. She stated that SHE is surely worth $40 for me to work with you. And she reminded me that I am worth it too. My tail is between my legs and depression is right behind me. Would you consider seeing me again through thrive works? If so, I would gladly fill out the remaining information and supply the $40 co-pay for each session. Thank you for taking the time to read this. I will understand if you don’t have any openings,

Joel

Wed, Sep 1, 6:35 PM (2 days ago)

Hey Joel.  I am glad to hear back from you.  And am glad you have worked to overpower your depression and moving forward to get back into counseling.  I will look at the schedule for an appointment a couple of weeks in the future.  This will give you an opportunity to complete the paperwork.  I work Monday Wednesday and Thursday evenings.  Thise evenings, I have two appointments at 6:30 and 7:30.  I also have every other Saturday morning session available.   So let me know what works for you. Thanks, XXXX

After 5 months, I have a scheduled appointment with the counselor that has helped me.

In addition, I have reached out to my Psychiatrist to schedule an interim appointment so we can evaluate my prescriptions. My Peer Advocate suggested that I explore all avenues. She pointed out that I shouldn’t feel guilty for wanting to feel better. And that my mental health was worth the efforts.

Using the Automated scheduling system, combined with guidance from my doctor, I have an appointment in 3 days to discuss my medicine.

Having depression and then needing to address the hoops and hurdles associated with getting treatment is depressing. If there is a way to reduce the stigma related to mental health issues, I am sure more people would decide to access treatment. But having to get approval for services creates a mental barrier. At least in my case, it created a roadblock that took me five months to get over.

How many souls are lost because of the perceived or real stigma related to mental health treatment?