Tag Archives: disability lifeline

Best Kept Secrets for Getting Affordable Treatment for Mental Illness

Mental illness can be present in any race, gender, geographic region, or class, but have you ever wondered why it seems more prevalent in those who are homeless or on the low-income portion of the class totem pole?

It isn’t that poor people are more suseptable to things like bipolar disorder, but that they often can’t afford to get the treatment that would help.

When I was at the Bipolar Disorder in Focus conference a month or two back, the lead speaker made it very clear that he has seen dozens of cases of lawyers or doctors who go to a regularly scheduled ECT (electroconvulsive therapy) session and continue on with their lives, business as usual.

Is someone in the upper class more likely to get better care? Have more treatment options? And have received care at an earlier stage in their illness? Yes, yes, and yes.

It isn’t that lower income people are more prone to mental illness, but that they are more prone to going longer without treatment because they can’t afford it, often making the illness worse. I’m totally guilty of this myself.

On top of that, treating mental illness is extremely expensive, and as patients we’re told that this expense will last the rest of our lives. Even with insurance, many plans wont cover mental health, and the combination of the two put us in a real pickle.

So, that said, I want to share some of the tips and tricks I’ve picked up along the way over the course of my journey to receive treatment, even if there were cartoon moths flying from my empty wallet.

Seeking any kind of treatment can be scary, it can be infuriating, and it can be heartbreaking to find out just how much it costs. But there is hope! If money or lack of insurance is an issue, you still have some options.

Seeing a Therapist

There have been times where the fear of spending hundreds of dollars on medications (that I didn’t have) has kept me from seeing a psychiatrist, for better or worse. Personally, in those times seeing a therapist once a week (or once every two weeks) has still been incredibly helpful.

  • Low-Income Clinic – some areas have low-income clinics for therapy that can either provide therapy for free or at a significantly reduced cost. Some of these clinics even have a prescribing psychiatrist on staff, to help people avoid the costs of seeing a psychiatrist as well.
  • Sliding Scale – many independent therapists will offer therapy at on a “sliding scale” depending on your income. I’ve found that this is usually still more expensive than the clinic, but working one on one with your therapist you might be able to make some kind of arrangement.
  • Students – students at local schools in programs for counseling have to practice somewhere, so if there is a school in your area it might be worth asking. Therapy with a student can often be free, or they may charge a small fee like $5 per session.

Seeing a Psychiatrist

This has been a big problem for me. Without insurance, I can afford to see the psychiatrist (but not afford my medications) or I can afford my medications (but can’t afford to see the psychiatrist!). Here are a couple ideas.

  • Low-income Clinics – again, these facilities often have one or two psychiatrists on staff, but since there is only one or two expect to have a waiting period before there is a slot available to be seen. Do keep in mind that in some areas (usually urban ones like here in Seattle) these clinic psychiatrists can be completely booked, period.
  • See a Registered Nurse – some facilities will allow you to see a RN who can prescribe instead of a full-fledged psychiatrist, and the cost is much cheaper. I’ve heard mixed reviews about people’s experience with this, but some people swear by it, so that’s an option.
  • Going Through a Hospital – some hospitals will allow people to see a doctor on call, or be assigned a psychiatrist to see regularly. Many hospitals (but not all) will waive the fees associated with these visits if you meet a certain financial criteria. On top of that, some will allow you to apply for this fee to be waived before going to the appointment (instead of trying to clear a bill you’ve built up) which I have found incredibly helpful. Ask you local hospital about such kinds of financial aid (this information usually wont be readily available, and you’ll probably have to speak with someone in a specific department).
  • State Coverage – state coverage varies from state to state and is not available everywhere, and if it is available there will probably be some serious criteria for applying. Here in Washington state, for example, you can’t be working while you are being covered by the state, and you have to qualify as having a disability. I was skeptical but applied as sort of a last-chance option, and they approved me right away -so if this is an option for you, I wouldn’t hesitate about trying to apply. Also, state coverage might only include specific doctors in the area (who may or may not be completely booked due to demand) so that is something to consider and ask about before applying.
  • Medicare & SSDI – so this is the “big guns” sort of option, as applying for SSDI can be incredibly frustrating and take a very long time. Most people are initially rejected, and must apply a second, third, or fourth time before being awarded. There are also some big emotional hurdles associated with the idea of being on “disability” so I would certainly say this is something that should be very seriously considered before going down this road. That said, if you can’t work or pay for your medications because things are so severe, it might be the right fit for you.

Paying for Medications

  • Patient Assistance Programs – this is something that is totally awesome and I would highly recommend. Most big pharmaceutical companies have programs where people who can’t afford their (overpriced) medications can get them for free after having their doctor fill out a few forms. Drugs like Abilify, Zyprexa, Seroquel, & more are available this way. I’m adding a section to the links page with more information, it is definitely worth checking out!
  • Samples – if your psychiatrist practices privately, he/she may have some “samples” laying around that were given to them (for patients) by the pharmaceutical companies. This is excellent if you’re trying something for the first time, because you wont have to fill an entire prescription with the possibility that you might decide you don’t like it a couple days in. Free samples make trial and error a lot more cost effective.
  • Changing the Dosage – some doctors are willing to write prescriptions in such a way that they will be cheaper for you to purchase. For example, prescribing a dosage double what you’d normally use, and then you break the tablets in half and take half at night so one “refill” lasts twice as long. Obviously this is completely at the discretion of your psychiatrist, and some are happy to tweak things a little so they’ll be more cost-effective for their patients.
  • Changing the Fill Amount – this is another prescription writing “trick” that can help when trying new medications. Have your doctor write an initial prescription for just a few days or a week’s worth to avoid paying for a month’s worth of something you may not entirely use. If the drug works out, have them write a full prescription, and if it doesn’t, no financial harm done!
  • Change Your Pharmacy – as I discovered fairly recently, the cost of each medication will change depending on the pharmacy (they’re allowed to add on as much of a mark-up on the price as they want). Some big-name pharmacies can offer you a lower price since they are buying in such huge bulk, I’ve heard a lot of good things about Costco, for example. I recently switched to getting my prescriptions at Target, and I am paying $25 a month less than I was paying previously.
  • Buy Abroad – I’ve had a few people tell me that it is much cheaper for them to buy their medications in Canada, for example (and hey, it is right up north for us here in Seattle). I’ve never bought any of my medications abroad, but some people feel comfortable even getting their drugs for a reduced rate over the internet. This can be risky since the formula for each drug can vary, depending on where you get it. Lithium purchased here followed by lithium purchased on the internet from India will not be identical, so changes in levels can occur. I would say that if you’re planning on going this route, I would highly recommend getting familiar with your sources and doing as much as possible to check them out.

Hospitalizations

Let’s face it. Sometimes a trip to the emergency room is necessary, and unfortunately sometimes even an inpatient stay in necessary. I always try to hold out as long as possible before taking either of these steps, but it is never because I don’t need the help. They are expensive, especially without insurance! However, avoiding treatment because of expense will usually only make matters worse. There are things we can do to work around these problems.

  • Charity Care – as I mentioned above in regard to seeing a psychiatrist through the hospital, many hospitals have a “financial aid” program to help people who can’t pay their bills. This can potentially fully cover ER visits, inpatient hospitalizations, and ambulance rides as well. However, each hospital is different, some have limitations about the amount they’re allowed to help you cover, and others don’t have a program at all. This is why it is so important to have an emergency plan in place before an emergency situation. If you do a little research to figure out which hospital in your area will be able to help you cover the cost, you can potentially save yourself a lot of financial trouble down the road. Talk to the billing department at your local hospital for more information.
  • Bankruptcy – I’m not all too familiar with the concept of bankruptcy, but I’ve heard a lot of people I know with big medical bills talking about it. It can be really easy to rack up big medical bills, especially with bipolar disorder, so declaring bankruptcy is something to consider as an option to clear up those bills.

Research Studies

Now, I wanted to add a little something about research studies on the end, because they will often provide completely covered therapy, doctor’s visits, and, well, medication potentially (at least what you’ll be receiving for the study) free of charge. In fact, some will even pay you for your time, or your transportation costs. This is something I’ve often considered, especially when I was without any resources. Obviously, this isn’t the right choice for everyone, but it can be a really helpful resource for folks who need help -or folks who want to help others!

Alright, so bipolar disorder is an expensive thing to treat, but there are things we can do to work around that fact. For someone who is low-income and has bipolar disorder, it often seems like we are in a position where it is easy for others to deny us insurance or care. I’m hoping that with the ideas I’ve provided, we’ll take the time to stop denying ourselves care!

Return of the Psychiatrist

Starting off this week with a bang! I got a call from the east coast this morning (apparently I’ve finally bugged the company I was previously employed at into submission) telling me my final paycheck is in the mail. I am so ready to have some closure with that situation, I never want to have to think of all of their ridiculous crap ever again. I also got a chance to wear one of my favorite dresses to work yesterday, which wouldn’t be a big deal if I had been able to fit into the darn thing over the last 6 months! To top it off, I woke this morning to clear blue skies and sunshine, which is very unusual for Seattle this time of year. To me, morning sun is synonymous with optimism, so any time I am lucky enough to get some it almost guarantees a great day!

Alright, alright, enough with the exclamation points.

In addition to those great things, I got a letter on Saturday from a local hospital/clinic that confirmed they are going to pay for my “medically necessary” doctor’s visits for the next 6 months.

Last year when I was really depressed I began seeing a psychiatrist for the first time in years. And I’m talking like seven years. 

I don’t think I gave him much of a chance. 

I was in depression mode, so it didn’t matter how clever or down to earth he might have been, I was extremely skeptical. On top of that, he had no basis for how I normally act or what a normal mood is for me, because by the time I met him I was so far gone there was very little of the usual me left.

I was desperate and in the depressed head-space (and had been for a while) so I had no clear memory of what “normal” was for me anymore, I couldn’t communicate what that was. When I’m that depressed, my thinking and feeling becomes so skewed that I have no frame of reference of what I’m talking about. I either can’t reflect on those “normal” periods because of where I’m trying to look at them from, or my interpretation is so muddled that I can’t discern which periods are which.

All I really remember from my visits is him saying (because he must have been repeating me), “Yes, I know you already said this episode should be over by now.” Apparently I was just a parrot exclaiming I should be coming out of the depression at any moment, because my episodes don’t normally last a year.

At the time, I was also completely oblivious to how complicated my case actually is, and it took numerous times of him actually telling me things were complicated before I began to listen and reflect on what he said.

Complicated? C’mon. But I admit I was overwhelmingly naive about my own situation. I don’t think it was until I’d tried the 15 different medications that didn’t work out that the weight of the word complicated really began to sink in.

Now that I have a better grasp on all of the elements and I’ve talked to numerous folks with bipolar disorder, I guess it is nothing less than truthful to say what I experience is complicated. Bipolar disorder is complicated even if it is your standard “right out of the book” case, but on top of that I have very rapid, sometimes hourly mood swings as well. Then sprinkle in the anxiety, PTSD, and OCD symptoms and it just becomes a big old stew pot of crazy.

When he began mentioning the possibility of ECT (electroconvulsive therapy), I scoffed & fled. Surely I wasn’t that far gone, right? Surely I didn’t require such extreme measures. And surely he must be even crazier than I am for bringing it up!

After my hospitalization we parted ways, I was put onto the Washington State disability program for healthcare and it didn’t cover seeing him. It was months before I found out they weren’t going to cover seeing any psychiatrist, even though I was admitted to the program for having severe depression. They definitely made me believe that wouldn’t be an issue, so I was more than a little frustrated when I was denied access to a prescribing doctor.

Now that the paperwork has gone through, I’ll be seeing the same doctor again. I couldn’t afford to go otherwise, and even just on the phone when I made the appointment (before my paperwork was finalized) I was told I needed to bring a $300 deposit to see the psychiatrist since I didn’t have insurance. Ahem. Yeah, right.

Since I’ve come out of the depression, I wasn’t initially planning to go this route, but after having a couple of those brief manic moments within the last month or so I’ve concluded it might not be a bad idea. Though infrequent, I really could do without those intense delusional moments, so I’d like to at least see what he has to say about things.

Honestly I am expecting to feel very embarrassed when I get in his office. I was pretty irrational the last time he saw me (in June), and I barged into his office on more than one occasion (not during my scheduled appointment time) hysterical and in tears. It is difficult to think about now that I’m in a completely different place, and I at least owe him an apology for the way I treated him.

Recently I’ve decided that I admire him for bringing up the possibility of ECT rather than despise him for it. He didn’t hesitate to lay out all the options, and I think that it is so important for doctors to introduce a patient to all the treatment options, not just a few. At the time it really scared the heck out of me, and in that depressed head-space I couldn’t seem to believe what he was telling me. I really do appreciate that he tried so hard to help me though, even if I couldn’t see it at the time, and that’s one of the reasons I’m going back to the same person.

So my first appointment is this week, and I’m working on revising my “symptom list” that I’ve been compiling over the last few weeks in potential preparation. The care I’ve been awarded by the hospital doesn’t remove the problem of ridiculously priced medications, but at this point I’m not sure what kind of route we’ll be taking with that anyway. The last round with this particular doctor, we pretty much explored every option possible, as far as medications were concerned. But, again, things are significantly different from the last time I was in his office, so I’ll be quite curious to see what happens.

Honestly, I’m just looking forward to having a conversation I can understand with him. If I can do that, the goal of the week will be met.

Several Unexpected Wrenches

I’ve been debating writing anything, but I suppose a line or two wont hurt.

I spent today feeling extremely discouraged.

The people I’ve been working with the last couple days have been great, the customers have (surprisingly) been great, but I am already seriously struggling with performing tasks.

Last time I took a job I only made it two weeks before having to leave because I couldn’t do the job anymore.

Today was only my second day of work, my second day but there has been an instant and dramatic effect on my mood. I only worked today for five hours but when I got home I spent three hours crying uncontrollably.

On top of that, I have been experiencing an excruciating amount of physical pain that has been making it almost impossible to focus on completing tasks while on the clock.

How am I already at my wits end when I’ve only worked 10 cumulative hours?

Things have never been this bad, I’ve never felt so awful so soon after starting a job and feeling fine when I began. It leaves me terrified and reluctantly concluding that things are getting worse.

Is my illness getting worse?

Discouraged doesn’t really even begin to describe how I feel right now. With the WA state disability budget cuts I have to work, I have no choice. I need money to live, that is just how the world works. I really wasn’t expecting this, and I don’t feel ready to face what it means for me and my future.

Reintegration Intimidation

I recently had to make a very difficult decision.

For the last six months or so I have been on a Washington state program called Disability Lifeline that provides medical and cash benefits to people who can’t work because of a debilitating medical condition of some kind. This program allowed me to see doctors (at specific clinics) and receive my prescriptions filled at no cost to me, as well as allotted me $197 a month for “cost of living” type expenses.

I qualified for the program after a long series of interviews and an appointment with a doctor (in my case a mental health professional in the DSHS office) that I was required to attend to assess my health and determine if I was fit enough to work.

In April of this year the depression I had been experiencing for eight or so months reached a dangerous low and I was struggling with extreme suicidal feelings. After six days in the psychiatric ward I discovered that my employers had fired me while I was in the hospital, shortly after I had requested a leave of absence. I was too depressed at the time to be furious, but luckily another job fell in my lap after only a couple of weeks (thank god for networking).

The new position was one that I had been wanting for over a year so I disregarded my psychiatrist’s hesitance about me starting a new job while still significantly depressed.

After only two weeks at the new job the stress of the position left me exhausted both emotionally and physically and I felt like I had sunk right back to where I was in the beginning of April. I knew that if I continued working I would, at best, become hospitalized again.

Needless to say, that was the point I applied for the Disability Lifeline program. As a young and (usually) ambitious  woman I didn’t particularly like the idea of throwing in the workforce towel and having to rely on financial aid this way but I was denied unemployment benefits and felt I had little choice. And, to be completely honest, when I applied I thought my chances of getting approved were fairly low.

I probably should have had a little more faith than that, given how fervently my psychiatrist expressed to me how much he didn’t want me working. Thankfully the woman who completed my assessment at DSHS agreed with him.

So what was that difficult decision again?

Oh yes.

This month the Disability Lifeline program was cut. A few days ago I received a brochure in the mail that explained that beginning November 1st, after a reassessment medical benefits may continue but there will no longer be any cash benefits. The sad little $197 a month that has been allowing me to pay enough of my bills to keep those ever loving financial predators away will not be available to me. What does that mean?

Work.

Yes, I have made the decision (well we’ll call it a decision, though it felt a little forced from my end) to reenter the workforce. Within the next two weeks I should begin reintegrating myself into the world of the employed, albeit I’ll be working only part-time. Thankfully my favorite out of the myriads of prior employers I’ve had is willing to embrace me (again). There’s something about being a 25 year old retail employee that feels a little bit like a joke in my eyes but all the same, I’ve concluded this isn’t the time to have a “what am I doing with my life” moment. What I’m doing is surviving and realistically, doing the best I can.