[comicgeek007]

I had an ED related flipout last night. Recovery sucks. Other than that I'm feeling pretty stable for now. Meds are doing their thing or maybe nothing at all, I don't really care at this point because I feel okay. Learning some coping skills and figuring out how to put them to use.

Aaaanywayyyy...

I was reading the insurance policy I'm going to be on (WONDERFUL read, by the way ) and found out that besides pretty good prescription coverage they cover no mental health.

This means unless I want to break my dad's bank with medical bills, none of the following can happen for the foreseeable future:

No SI or sui stuff requiring medical care.
No counselors outside the one I got the grant for.
No inpatient for any reason, including med changes.

However this is still better than SOL coverage, which is what I'll have the second I turn 18 and my abusive and estranged mother no longer has to pay for it.

Guess I'll have to stay stable for the next few years.

[ultramar]

Are you sure about this? A Federal mental health 'parity' law was passed a couple of years ago, requiring insurance companies to cover for mental health issues 'on par' with the coverage they offer for 'physical' health issues. In other words, your mental health coverage should be the same as coverage for diabetes (meds, appointments, tests, hospitalization if necessary), according to law.

What is your insurance? Is it private? Do you get it through a job (or a parent's job), through the state (i.e. Medicaid)? Did it recently change and if so, why and how?

I can't imagine a health insurance that doesn't cover inpatient for any reason? Because even the minimal ones (I think it's called catastrophic insurance) will pay for emergencies (even if only for emergencies).

I know some about health insurance through my job -maybe I can help you a little if you let me know what kind of insurance it is, etc.

Also, what do you mean by 'grant' to pay for your therapist?

[comicgeek007]

I'm going to get it through my school, so I don't know if it even qualifies to be scrutinized under the mental health care parity law. Even so, I looked at it again and supposedly as long as I don't go anywhere that specializes in mental health or substance abuse, it's covered most of the way. So if I get sent inpatient it would have to be at a normal hospital rather than anywhere that actually focuses on mental health. I've only ever been inpatient at psych-only places, so I don't know what the potential difference in care (or lack thereof) is. It's still not the same as their injury/sickness coverage because you would GET to see a specialist not affiliated with a general hospital for an injury or sickness, it just wouldn't be covered quite as much. But try to see a specialist not affiliated with a general hospital for MI and you're SCREWED.

My insurance currently, and as it will be for the next couple of weeks, is private through my mother's employer. It offers nothing but emergency care in Mississippi which is where I am most of the year. It is changing soon because I am turning 18 and my mother will no longer be obligated to pay for it (my dad runs a struggling partnership with one other person and they can't afford to pay for health insurance through their business, and as part of child support mother was ordered to pay for children's health insurance). Also, my stepmom is adopting me when I turn 18, so that would cut off mother's insurance automatically. My dad's had cancer twice and so as of now, insurance companies don't want to cover him and his family.

The insurance brochure is here:
http://www.health.msstate.edu/health...r2013_2014.pdf

As for the grant, my family doesn't make a lot so I qualify for a state-issued counseling grant in MS so I don't have to pay for my "permanent" counselor.

Looks like pdoc visits are covered same as any other physician's visits. I see no provision for psychotherapy, but your university may already have a counseling center that is available to students. The hospital probably can't be a stand alone psych facility, but must be a psych unit within a covered hospital (that's just my guess and you should call the number and definitely get that clarified). If you self injure or attempt suicide, no related treatment as the result is covered.

[comicgeek007]

Originally Posted by 1914sierra

Looks like pdoc visits are covered same as any other physician's visits. I see no provision for psychotherapy, but your university may already have a counseling center that is available to students. The hospital probably can't be a stand alone psych facility, but must be a psych unit within a covered hospital (that's just my guess and you should call the number and definitely get that clarified). If you self injure or attempt suicide, no related treatment as the result is covered.

okay. thanks for the clarification.

Again, the best thing to do is call the provided number and get clarifications. My interpretation of the hospital coverage is my best guess, but I think I'm pretty close. For instance, I use a full service hospital that has a psych floor within it. It sounds like that would be covered if the hospital is one that is covered under this plan. The psych hospita.l my son was in is a private, stand alone psych facility. It would not be covered under your plan if I'm reading that right.

If I am admitted before I have attempted to harm myself in any way, my treatment would be covered. If I made an attempt and was admitted, the bill would be on me.

Oh, and apparently you must give up bungy jumping and sky diving.

[ultramar]

I wouldn't worry about stand-alone psych facilities not being covered. Some of the *best* (regular) hospitals in the country have excellent inpatient psych units. Also, outpatient psychiatric practices (where you can see psychiatrists and therapists) out of hospitals, rather than private (I think this is what you're saying your insurance covers) can also be excellent.

As far as planning (considering limitations of the insurance) perhaps you could scout out (with the help of your pdoc at school) a good, large academic medical center, with a good psychiatry department. You could make a plan with your therapist and pdoc at school to be sent to that hospital if you were ever to need inpatient care.

Will you be able to continue seeing your current therapist and pdoc at school?

If not, again I would check out which hospital in that area has the highest ranking psychiatry department, where you could seek outpatient care. I know a 'hospital' environment sounds daunting, but it can be excellent if you go to the right hospital.

It does sound like outpatient (not only emergency) psychiatric care is covered, so you shouldn't have a problem there. I do think that insurance through a university would have to abide by the mental health parity law, but you can make some phone calls and find out more information about all of this. If your insurance offers in and outpatient psych care, then it sounds like it abides by the law. The fact that you can't go to any facility you want is an unfortunate reality of many insurance plans -what's 'in-network' and what's not.

If you're ever in a position where you cannot afford medical insurance (post-school), you could apply for Medicaid. I know Medicaid has a bad rap, but the patients I work with who have it get excellent care --hospital outpatient clinics and inpatient have to accept it by law (because all hospitals receive federal funding of some sort or another). Again, it all depends on how good the hospital is.

I'm going to take a look at the plan you posted a link to.

I think you'll be okay, though! I would recommend calling the insurance company, though, to clear up any questions you have.

[ultramar]

I just read through the policy. It's pretty typical, except for one truly bizarre thing (at the end):

The good, or okay:

1) For most medical care (except emergencies) you need a referral from the student health clinic. However, this does *not* apply to mental health treatment --this is great, it takes out one step of the process.

2) Mental Health Treatment: Quote "Paid as any other sickness" This is very important, it's great (and probably from the law I mentioned).

As with *every* health insurance policy (that I know of), if you don't see providers within their network, you will have to pay large out of pocket fees.

In-network for them includes two hospitals (for in and outpt care) and a list of UnitedHealth providers (outpatient). You can research those two hospitals and see which you think is best. Also, if you can't continue to see your current providers, you would have to choose from the UnitedHealthCare list.

Your policy says nothing about therapy specifically, however I would think that since there's mental health care parity, it would be. Nonetheless, I would call and ask.

So as far as inpatient, you are limited to those two hospitals. However, in the case of an emergency (i.e. psych emergency) you can go to an out of network hospital and they say they will pay what they would if it were in-network. Though if I were you I would call and make sure they would pay for your entire inpt stay in that manner or only the ER and then you'd have to transfer (though I doubt it).

So it sounds like a decent and typical policy to me.

The only exception is something truly from bizarro-land and sounds actually like a kind of rejection of this on moral grounds or some such thing, because it's extremely unusual:

They do *not* cover suicide attempts or self-harm (i.e. if you ended up in the ER and/or inpatient for these reasons). Period. There is a separate provision stating that if you are harmed/become sick in some way from not taking your medications as prescribed by a doctor, this is also not covered -though to me it sounds like part of the same thing.

The only question I would have about this (if you make calls with questions) is if, if this were to happen would they not cover it at all, or if they would cover it as if it were out of network (partial coverage). But it sounds like it's not covered at all.

So, as I say, it sounds par for the course, and you do get full mental health coverage as if it were any other illness --with the exception of the sui/si stuff, which really sucks. Hopefully, this will not end up being an issue, though!

UHC Options PPO is not a single hospital, it is a network of healthcare facilities and physicians across the country, so you do have more than two hospitals that are available. Run a search for United Health Care Options PPO and you can find their provider/ facility search. I took a quick glance at it and there is a separate search for mental health providers. If I get on my computer I'll attach the link for you, but it wasn't difficult to find.

[ultramar]

[quote=1914sierra;3192474]UHC Options PPO is not a single hospital, it is a network of healthcare facilities and physicians across the country, so you do have more than two hospitals that are available. Run a search for United Health Care Options PPO and you can find their provider/ facility search. I took a quick glance at it and there is a separate search for mental health providers. If I get on my computer I'll attach the link for you, but it wasn't difficult to find.[/qu

That's great, I'm glad you found that --I thought it just involved outpt providers!

[QUOTE=ultramar;3192596]

Originally Posted by 1914sierra

UHC Options PPO is not a single hospital, it is a network of healthcare facilities and physicians across the country, so you do have more than two hospitals that are available. Run a search for United Health Care Options PPO and you can find their provider/ facility search. I took a quick glance at it and there is a separate search for mental health providers. If I get on my computer I'll attach the link for you, but it wasn't difficult to find.[/qu

That's great, I'm glad you found that --I thought it just involved outpt providers!

I've spent so many years hassling with insurance changes that I've just had to learn to research this stuff out of pure survival. The question will be if any of these hospitals actually have a psych unit or not.