The thing about health insurance is that is it not profitable to insure the sick. A much more reasonable business plan for an insurance company is to convince all the healthy people in the world that insurance is necessary, and to deny coverage to the sick, and as a result, all of the clientele that you insure would have little need of the insurance and all those premiums would be profit.
But having said that, insuring someone like me just doesn't make sense for the insurance company. After all, bipolar is an ongoing condition, its not just going away, and the costs can be high. One of our concerns now that we are shopping for coverage is the cost of prescriptions. Many of my meds are available at a very reasonable cost. But some are not. One pill used to cost $30 a day, now reduced to $20 a day, because it has been released as a generic (still only one allowed manufacturer but they've offered a 'generic' alternative). A second pill, used for sleeping, has been wonderful in that I'm now getting a full eight hours of sleep. That one costs $10 a night. Combined with the other meds that's over a thousand dollars a month just for prescriptions.
And then there is the therapy that I've been receiving. I don't remember the exact amount, but the full bill for a visit with my psychologist is around $180 per session, double that to see the psychiatrist. Of course the insurance carriers have negotiated step discounts. But even then, a few visits to the psychologist and a once a month with the psychiatrist and we can add another $500 that has been covered by insurance. Bottom line is that for an insurance company to make a profit on me, the premiums would have to be more than $1,500 a month. We can't afford that.
So then, forced by economic uncertainty, I must explore other options. This is what the insurance industry is trying to accomplish, and I guess, to a certain extent I can't blame them. How much is a good night's sleep worth? If you can get a so, so, night's sleep with a cheaper medication why spend over three hundred dollars a month to realize an improvement? Likewise with the other medication. Abilify is designed to increase the effectiveness of the anti-depressants I am on. But does its effectiveness justify $600 a month?
When insurance is covering all of these meds, it is easy to simply assert that I need whatever medications that will be best for my health and the maintenance of a reasonably stable and normal state of being. When its coming out of our own pockets, then we are forced to do a cost/benefit analysis. And in the back of my mind is the recognition that in spite of the temptation, the cardinal sin of being bipolar is going off of medications that are stabilizing one's mood.
And then there are other inappropriate thoughts. My alcoholic mind says "I was doing just fine relying on Scotch, and for a lot less than $1,000 a month." Actually, a thousand dollars a month would buy some very good Scotch.
The other thought that comes to mind, more reasonable than Scotch, is running to Canada. This is the second time this has come up. Moving there is not really an option. But I know that others in the past have gotten a physician in Canada to prescribe the meds, and then purchased them at a Canadian pharmacy for a fraction of the cost in the States. I don't know if this is legal anymore. But with Canada only 50 miles away, it is a thought that comes to mind. I could drive to Creston, BC for less than $1,000 a month.
Oh well, things will work out.
In the mean time, it is Thanksgiving, family is coming, and I'm looking forward to the day with meds that will last a week before yet another decision will have to be made.
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