This article was written anonymously. Please do not write to Dr. Grohol about the content of this article unless you’d like to either add on to it with your own personal experiences about your difficulty in receiving adequate mental health treatment from your managed care entity or HMO, or you’d like to respond to it in some other way.
If I’m rushed into surgery today because my appendix is about to rupture, my HMO will pay 100 percent for surgical services and hospital- covered expenses.
When – in my case, not if – I experience another major depressive episode, the HMO will pay 50 percent up to no more than $1,000 per year for psychiatric or psychotherapeutic care, or any combination of both. At local rates, that works out to about one appointment with someone per month or so, with me laying out about $1,400 of my own when you add in co-payments for visits and prescriptions.
The HMO recognizes that a ruptured appendix can lead to peritonitis, which can lead to death. So what does it think that acute unipolar depression leads to? A bad hair day?
In truth I should be elated that my employer’s HMO is so beneficent. The previous provider, if it can be called that, made no provision at all for mental health care.
Why this discrepancy? It’s purely a matter of probabilities and money. The HMO knows I won’t have my appendix removed more than once. On the other hand, I could be faking this depression thing, though only heaven knows why. And, after all, you really can’t measure or quantify depression, can you? No test or x-ray can confirm that I’m tickety-boo and all better again.
In effect, the HMO is saying I’d best not sink very far or for very long. In a 1995 book titled The Beast, Pulitzer Prize nominee Tracy Thompson frets that her 10 days of essential in-patient treatment for depression at a Washington hospital cost her employer’s insurance carrier $20,000. By comparison, my HMO will pay 50 percent for no more than 10 days per year – with a lifetime maximum of $10,000. I don’t need a CPA to tell me to dread ever finding myself at the precipice that Thompson did.