The price of good health

Here’s my thing about the current mental health system. I know everyone has a different “thing”; this is mine at the moment.

Despite really needing them, I have exhausted the maximum number of Medicare-subsidised psychologist appointments that I am entitled to in a calendar year. I ran out in April. 4 months into the year!! Leaving me in the unenviable position of having to pay $145 per one hour session weekly with no Medicare rebate of $85 if I want to keep seeing my counsellor and improving my mental health. Not a great encouragement to continue therapy.

$145 is a lot of money for someone who has been off work for 100 days and ran out of sick leave after four and a half weeks! But this is not just about me, it’s about every patient who is getting treatment for mental illness. It’s a lot of money to anyone! So I tried to go without my psychologist session,then I tried spacing them out to two weeks or three weeks. Didn’t work terribly well or please my doctor or psychiatrist! Or me for that matter.

Luckily for me, in a freak moment of paranoia in 2010 I signed up for income protection insurance after a work colleague was diagnosed with cancer and couldn’t get insurance. Because of this I am getting a kind of substitute wage. So I am doing 10 tonnes of paperwork every month for the insurance company to pay me a benefit in arrears. So far I’ve had one payment. It was a great payment, but it was once! But there are a lot of people out there in the world who wouldn’t have been prepared to pay $85 per month for the last 4 years for the sake of an insurance payout that might never be needed. Thank goodness I did pay for it, though!!! It cost me but I am getting the benefit now.

In the case of people without income protection insurance they would be doing 10 tonnes of paperwork for Centrelink disability or sickness benefit or health care card or something else similar! For a lot less money probably. The government doesn’t match your current wage.

In an effort to address this problem with paying $145 out-of-pocket each week, I changed my insurance over in April so that I now pay a lot more per month for better psychologist and psychiatrist and inpatient psychiatry cover. Again, not something a lot of people would be prepared or able to do. Unfortunately I then had to wait two months to be able to use it! And I only get $250 worth of psychologist cover, not even two sessions!! Not quite worth it for that part.

Luckily, there is another benefit of income protection insurance that I was not aware of; in their portfolio of helping me they have agreed to fund 10 sessions!! Thank goodness!! And they have offered to put me through a meditation course, which I was already thinking of doing, so there’s a few perks to having paid privately for this insurance. But like I say, how many people could or would pay for this? How many people develop mental illness, which never comes in a planned way or at a convenient time, and have to make the choice between paying a huge amount  of money or go without treatment?

So this is the reason why there are crazy and hurting and needing-help people walking the streets; the private system is expensive!

And you can’t get admitted in the public system unless things are diabolically bad! They refused to admit me when I was suicidal and didn’t think I could keep going. I begged them to!! They would not do it. They just kept saying it would do me more harm than good. I kept begging. They kept refusing. They won. I got sent home. It wasn’t nice!!

They asked me if I had private insurance. Yes, yes I do. Well we’ll look for a private hospital bed for you. Okay sounds great, I just need to have someone look after me. Well we’ve called your insurance company and you will be $2500 out of pocket up front plus $400 per day. We don’t know how long you will need to be in hospital. Ummm, okay, maybe not! That’s a whopping lot of money! I know you can’t put a price on your health, but that’s a large pile of money that could be put to some other large life investment! Another reason for upgrading my insurance.

Now that I’ve served my waiting period of two months, I can get private hospital admission for only a few hundred dollars out of pocket. Will I need it? Maybe not, but I’d rather know that I can get it if the need arises because not being able to access it last time left me feeling even more desperate when I didn’t think it was possible!! But it’s a toss up, spend over a hundred a month to save a couple of thousand…how long til it adds up to that much anyway? But I have a plan to reduce my insurance if I don’t use it this year.

So instead of a hospital admission, the community psychiatric team came and visited me or called me once a day for 10 days until the new medication had kicked in and I started to see life in a more hopeful light. I have to say they were amazing and helped me so much. And I continued to see my usual GP and psychologist in that time, as well as a psychiatrist in training at the local office.

Which brings me to another point. I have been seeing a doctor once a week since last November. After the worst episode of suicidal thoughts and desperation I saw my GP twice a week for a couple of months, then went back to weekly. We’ve planned to stretch it out to fortnightly but we’ve never quite gotten there due to either a relapse or medication change.

The first doctor I saw charged me $73 per session. This is pretty standard. My current GP who I’ve been seeing since December usually charges $70 per session but bulk bills me because I’m a mental health patient and he doesn’t want mental health patients to not see him because they are worried about the cost. Which is a very important consideration!! And it actually does make all the difference! I know I can go in and see him anytime and I don’t worry about the cost, when I would otherwise consider that before booking an appointment.

Imagine $70 at least once a week since December. That’s 6 months. 23 weeks. If I had had to pay $70 per session I would be at least $1600 out of pocket!! Again, a lot of money for someone who hasn’t worked for 3 of those months. Or anyone, for that matter!! The Government has put in place a medical safety net so that if you have medical costs over a certain amount you can get a benefit at tax time. But you have to spend even more than this before you get the benefit, as I understand it. You really have to spend a fortune to get any help or subsidy.

Bulk billing is one of the greatest inventions but it relies on doctors being willing to take a Government-determined payment for their services rather than the larger fee that they could justifiably charge. That takes a dedicated and altruistic physician, and I’m so glad for every doctor that offers bulk billing! You are the hope of the sick and poor!!

Doctors that don’t bulk bill are private (non-hospital) psychiatrists. Which is understandable because they invest more than 10 years of their post-high school life to achieving the knowledge and expertise to work in that position. My psychiatrist charges $315 for the first consultation and $215 for subsequent appointments! Understanding this the Government rebates $221 for the first appointment and $113 for the second appointment. Not bad but still a fair amount of money to pay on a regular basis.

Then of course there are the medications. Lithium, venlafaxine, quetiapine. Diazepam for emergencies when I’m really anxious. Pantoprazole for gastric upset on lithium and venlafaxine. Levlen to avoid becoming pregnant on lithium and quetiapine. Cholecalciferol for reduced vitamin D from spending the last 3 months mostly indoors. Tooth mousse for increased cavities on quetiapine due to dry mouth. Anti-perspirant for over-heating and increased sweating on venlafaxine. High protein diet for iron deficiency. Low cholesterol diet for high cholesterol due to eating badly and quetiapine. Calorie restriction for increased appetite due to quetiapine and lithium and venlafaxine. Altogether it comes to about $150 per month for meds. There is also a prescription safety net, but this only comes into play after you have about 60 scripts dispensed in a calendar year. I’ll come in just under this so no safety net for me.

So that’s my whinge for today. From my position I feel lucky for the investment I made in insurance years ago, and I’m glad that I now have better insurance for the present and I’m glad that I’m in a position to afford these things. I’m not wealthy but I’m comfortable, and I feel for those people who really don’t have the money to get the treatment that they so badly need. Should we be subsidising treatment more than we do? Should people be made to have better insurance? Who pays for all of this? It’s not really an answerable dilemma, but I’d like to be more thankful that I’ve been able to get the treatment that I needed at times when I’ve really needed it!! Maybe not as much as I wanted but enough to keep me safe and pushing on.

And as I always say to my patients, I need to thank my stars that I was born in Australia not America. If I lived in America I would have had to pay for all of this and pay for it dearly! I’d probably have taken out a $20,000 personal loan by now or have completely used up our life savings.

Health. When it’s good, you don’t even think about it; it’s just there and we all take it for granted. We expect our bodies and minds to work in a predictable manner. We feel let down when they don’t work to our plans despite it being quite the miracle that all the intricate functions of our bodies work smoothly without a hitch.

But I’d like to take more time to be thankful for the days when my health comes to me easily! When it doesn’t take doctor’s visits, hospital admissions, psychologists, psychiatrists, medications, time off work to achieve a type of health. When I wake up and I’m just well! It really is a miracle and I want to appreciate it.

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