The Financials of Bipolar Treatment
I’ve written about a recent trip to the emergency room, due to a manic episode cropping up. Now, the medical bills are rolling in.
It’s no surprise that the US costs for mental illness treatment vary widely, but are usually shockingly high. I knew this when a manic episode progressed far more quickly than I’m use to a few weeks ago.
Before I begin, I want to share a few statistics about the average income and disability level for households with bipolar disorder.
And despite 31.9% of patients with bipolar disorder having completed some college education — compared with 26.9% of the general population — 35% of the former had an income below the 10th percentile, compared with 9.9% of the latter. Additionally, mean annual household income for patients with bipolar disorder was $43,662, compared with $96,319 in the general population.
Further, 66% of participants with bipolar disorder were single, compared to 47.9% of the general population, and 39.4% of the former received a disability pension, compared with 11.5% of the latter. source
One Thursday evening in early January, my psychiatrist prescribed me a low dose of Geodon in hopes of bringing me out of a severe depressive episode. I was set to start my first dose Friday morning, but woke to find myself in a particularly good mood. Nonetheless, I downed 500 calories and popped my first purple Geodon by 6:00 AM.
I spent that weekend wondering if, perhaps, I was starting to feel the effects of hypomania. I woke up Monday morning at 2:00 am, and didn’t go back to sleep until almost 48 hours later.
I spoke with my therapist at 9:00 am on Tuesday, 30+ hours without sleep. I rambled to her about the corruption of the medical industry and my fears that my psychiatrist was intentionally worsening my episodes to push me to expensive medications. I’d done some research and word-vomited some of my findings. I lost my train of thought often and, generally, didn’t make much sense.
I have a history of paranoid and grandeur delusions with some mild hallucinations. My therapist was so concerned about psychosis that she pushed for the ER. My husband and mom agreed. She was mostly concerned that I would stop trusting my husband.
I felt that, if I didn’t go, she might call for an ambulance to show up.
So, that afternoon, my husband took me to the ER to see if they’d give me something to sleep until I could see my psychiatrist. And, if not, take me inpatient for a few days to stabilize me.
They told me to take Unisom and sent me on my way. If you’ve ever experienced the extreme sleep deprivation of mania, you know that my illness laughed in the phase of such a low-level OTC medication. This past Spring, not even Ambien could do the job.
I want to talk about the costs of this visit, my insurance coverage, as well as the costs of my other Bipolar-related expenses so far this year. My experience isn’t unique. And my insurance isn’t the worst. My medication is relatively inexpensive, but this illness can be expensive to treat.
First off, let’s talk about my deductible and out-of-pocket maximums. These numbers reset on January 1st, 2022. Meaning that I started off this year with no coverage.
Blessedly, my deductible is only $500. From what I’ve been told my family and friends, this is quite low. My individual out-of-pocket maximum is only $1,500. After I’ve paid $2,000 in a given year, our insurance kicks in at 80%.
My prescription deductible is $7,200. After that, I’m told our insurance will kick in at 100%. I’ve never actually come up against what they will and will not cover, other than Vraylar. Vraylar, at retail price, is $1,200/month in my area.
If you’re coming up against your insurance, check out this savings plan from the Vraylar manufacturer. This is what I was able to do during my 6 weeks of Vraylar.
We were able to get prior authorization after an extensive fight with records of my symptoms and previous medication trials. However, even after receiving authorization, nothing was actually covered, due to our high deductible.
We would need to spend $1,200 a month for six months on prescriptions, before our insurance would kick in for half a year.
Emergency Room copays are $300, no matter what we’ve paid for the year.
I’ve not received the direct bill for the hospital visit, but I have received an explanation of benefits for the claim. Before some sort of “discount”, the claim for the useless visit was $533 and some change. I’m expected to be billed at $388.
I understand that an inpatient visit would have been more expensive. As it stands, I didn’t receive any treatment. I wasted several hours of my life and a significant chunk of money to be told to grab a $3 OTC sleep aid on the way home. One that didn’t work, by the way. I spent every other night for a week and a half laying wide awake, shaking, but unable to sleep.
My medication is blessedly inexpensive. For 3 months of 200 mg Lamictal, I pay $24. I also take 2, 25 mg tablets a day, which costs me another $24 for three months. My (useless) Trazadone prescription at 50mg for 1 month only costs me $4. And my (subtherapeutic) dose of Lithium 300 mg costs $14 with a GoodRx card. I bypass my insurance, as GoodRx saves me at least a few bucks.
That’s $34 a month.
Lithium requires frequent blood work to check levels and kidney function. I’m currently having blood draws every two weeks, until we stabilize my levels. This would be $120 per month, if I waited for the bill to come in. By paying the day of, I’m able to save $12, making my bill $48, or $96/month.
This cost is a big barrier for many people. While the cost of lithium is low. the bloodwork can mean that some people pay over $100/month to get started. Eventually bloodwork can be cut back to once every few months.
I am incredibly lucky in the therapy department. My husband’s company pays for the entire bill, as long as I use a telehealth service called Teledoc. I was able to find a therapist I work well with on the second try. If these visits went to our deductible, I would be paying $90 per visit. That is $180 or $360 per month.
After 25 visits, my therapist has to prove medical necessity to be reviewed and approved (or denied) by my insurance company. My psychiatrists office requires me to meet with, and prove, a therapist at least once a month.
Prices like this firmly put insurance out of reach for many people with bipolar disorder.
My psychiatry visits through Teladoc are also free. However, I’m unable to use the service as Teladoc refuses prescriptions for most Mood Stabilizers and Antipsychotics. These are the mainstay of treatment for Bipolar Disorder, Schizoaffective, and Schizophrenia. Teladoc refuses to provide accessible psychiatry to those with severe mental illnesses.
As a result, I see a local psychiatrist. I currently have $300 worth of psychiatry claims being processed for the first 6 weeks of 2022.
Mental illness often comes with a feeling of shame. Or the sense that you’re a burden on your loved ones. As a stay-at-home-mom, I feel this a lot. My husband is a stable, healthy man who works his butt off and makes good money, due to his job as an engineering manager.
While my expenses are relatively low, we’ve been billed $624 within the first 6 weeks of 2022.
My story proves that, at least some, small town hospitals are inadequate at treating anything beyond suicidality. Even good insurance can place a high financial burden on those with severe mental illness.
And mental stability can come with a high price tag.