No mental health coverage

*** copied from old BL journal ***

I met with a health insurance broker. Signed everything for what's called an HMO 20 plan and it looks like my coverage will begin on October 1st. I read through the pamphlet and everything looked fine. I came home and hopped online to verify that there was mental health coverage. There is none.

All I really wanted to do was see a therapist but now thats going to be delayed 30+ days. I'll just have to toughen up and deal with shit. The only problem is that I don't deal with things in a healthy manner. I want to learn but, shit, I need MORE than what the 12 step programs offer.

I gotta tell ya, the US is a piece of shit country.

Aetna HMO 20


Details at a Glance

* Plan Type
* HMO
* Office Visit for Primary Doctor
* $20 Copay
* Office Visit for Specialist
* $35 Copay
* Coinsurance
* None
* Separate Prescription Drugs Deductible
* $250 Individual
$750 Family
* Prescription Drugs
* Generic: $15 Copay
*
* Brand: $25 Copay
*
* Non-Formulary: $35 Copay
* Health Savings Account (HSA) Eligible
* No
* Out-of-Network Coverage
* No
* Out of Country Coverage
* Yes. Paid as out-of-network benefits

Physicians

* Primary Care Physician (PCP) Required
* Yes
* Specialist Referrals Required
* Yes

Preventive Care Coverage

* Periodic Health Exam
* $20 Copay
* Periodic OB-GYN Exam
* $30 Copay
* Well Baby Care
* $20 Copay, Age and frequency schedule apply

Prescription Drug Coverage

* Generic Prescription Drugs
* $15 Copay
* Brand Prescription Drugs
* $25 Copay
* Non-Formulary Prescription Drugs Coverage
* $35 Copay
* Mail Order for Prescription Drugs
* Generic: $15 Copay
*
* Brand: $25 Copay
*
* Non-Formulary: $35 Copay
*
* Days Supply: 30-60
* Separate Prescription Drugs Deductible
* $250 Individual
$750 Family

Hospital Services Coverage

* Emergency Room
* $150 Copay
* Outpatient Lab/X-Ray
* $30 Copay
* Outpatient Surgery
* $400 Copay
* Hospitalization
* $450 Copay Per Day, up to 5- day maximum Per Admission

Maternity Coverage

* Pre & Postnatal Office Visit
* $450 Copay Per Day, up to 5- day maximum Per Admission
* Labor & Delivery Hospital Stay
* $450 Copay Per Day, up to 5- day maximum Per Admission

Additional Coverage

* Chiropractic Coverage
* $30 per visit. Limitation: treatment over a 60 consecutive date period per incident of illness or injury beginning with the first day of treatment. Chiropractic care only covered through natural alternatives.
* Mental Health Coverage
* Not Covered

Additional Information

* A.M. Best Rating
* A as of 06/16/2008
* Electronic Signature for Application Available
* Yes
* Will insurance company obtain and pay for medical records?
* Yes
* Additional information about this health insurance plan is available in the documents below.
Plan Brochure
Exclusions and Limitations

 

I can't believe that there isn't any mental health coverage!

Insurance should have to cover it IMO.

 

That's the problem with relying on insurance companies to fund health care: they can cover whatever they feel like. Which generally works out to the bare minimum required to convince people to pay for the plan. Mental health coverage, especially in private (non-work) plans rarely exist, and if they do are very expensive and cover very little.

Don't even get me started on the whole 'pre-existing condition' bullshit. When I was looking for a personal plan to cover the stuff not covered by heathcare (which in my province is a LOT), I found a plan which cost a bit extra but had a really low co-pay for medication, as well as direct billing. I need this, as I have low-level asthma, and don't generally have the $150 in disposable income to pay for one of my medications. So I fill out their form, and they say that I'm approved, except that my asthma is a pre-existing condition so they won't pay for any asthma meds. I mean FFS, that was the whole reason I was getting the plan! I told them where to stick it, of course.

 

Its funny, I got into rehab for free through county assistance and upon my discharge I qualified for Medical Assistance through the state.

I stopped taking my medication two weeks prior to rehab (mid August 2009) and haven't found the need to go back on it. Apparently, I was misdiagnosed for depression in '93 but my drug use was contributing to my depression.

I'm glad I no longer take anti-depressants. They served their purpose at one point for me but the side effects were a constant source of struggle.

If I ever find myself in that dark place in my head again while clean, I will consider going back on them but for now I'm grateful that this isn't the case.

I am still disgusted by our health care system here in the States and it sounds like the UK is in the same shape as we are.

Dave, have you found anyone that will cover your asthma meds?