Tuesday, July 28, 2009

Medicare cuts and how they affect people with mental illnesses including myself

Medicare cuts have been affecting me in numerous ways lately. I used to have weekly therapy with a therapist who I trust and respect and have known for a couple of years now. I relied on this therapy to help me sort out delusions from reality, and to find ways to improve my overall mental health. My therapist does a lot of reading and researches various issues that may help her clients. For me, she has looked into the possibility of Celiac Disease and the fact that I have a physical problem with absorption. She was the person who figured out that I did better on injections of Risperdal as opposed to the oral medications, because my body doesn't absorb the oral ones correctly. That was an immensely helpful bit of information, and although I had sort of figured it out myself, the reason the ARNP who prescribes my meds put me back on the injections was probably because of my therapist's recommendation. So today, rather than having auditory hallucinations and delusional thoughts controlling my mind all day long, every day, I can think pretty clearly most of the time, and actually function, unlike a few months ago, when I was living in a hellish nightmare because oral meds don't help me much.

But alas, Medicare decided that the community mental health center I go to needed to have a doctor sign off on all therapy appointments, or, basically, Medicare would no longer pay the center. Since the center had no funds to hire such a doctor, what happened was that a lot of people got cut off from getting therapy because Medicare would not pay for it anymore. I could ostensibly go somewhere else for therapy, but I don't want to start over from atom when I already have a helpful therapist who knows me well. So, my therapist has worked it out that I can still see her via group therapy, as twice a week for the past couple years that is how it has worked: I go to a group; the other two weeks I had individual therapy. Now there is just the group. The group consists of only myself and one other person, so it's still helpful, but it's not as helpful as weekly therapy was.

Yesterday, when I went to the group appointment, I found out that Medicare has also cut off all funding for my ARNP (the psychiatric nurse practitioner who prescribes all my medications and has for a couple years), so she is not going to be the prescriber I see any longer. She lacked one particular type of certification that Medicare just decided all ARNPs must have in order to be paid by Medicare. This is also disappointing, and it's also obviously a way for the government to cut funding for Medicare. I already went through a couple of other doctors at the center back when my original ARNP left the center, and I had numerous other doctors before that. I had been happy to have developed a lasting relationship with this one and she is a kind and caring person, so I liked her. Now I have no choice but to start from atom with a new doctor. I could ostensibly leave the community mental health center behind and go to a psychiatrist with a private practice, but the reason I have never done that is because I do not have the funds to cover the 20% of costs that Medicare does not pay. So I'm basically stuck going to whoever is assigned to me at the community mental health center.

In a related event, I went to physical therapy yesterday, and one of the owners, who kindly has allowed me to get physical therapy for months without paying that 20% I cannot afford to pay, told me that I will be finished with PT soon, as I am doing better with exercise. I know that part of the reason for this was that I was getting care without paying for that percentage, and it is probably difficult for a business owner to allow that for very long. She told me I can still use the equipment at the center on my own, if I pay a nominal fee. Whether or not I do that just depends on how much that fee is. What some people consider nominal is expensive for others. Nonetheless, I am eternally grateful to her and her partner who allowed me to get into better shape there and helped me with my chronic pain without charging me for that percentage of their services. Most people would never have done me that favor.

So, although Medicare is obviously far better than not having any insurance at all, it still has numerous setbacks. I do not get Medicaid as they decided a couple years ago that my income was too high, which, considering the amount of my actual income, is pretty ridiculous. Due to this, I have piled up enormous debt in medical bills I cannot pay, and continue to pile it up all the time. I will never have good credit as long as I live due to the amount of medical debt that has landed on my credit report over the past 15 years. Anybody who tells you medical debt is looked at differently than other debt by credit agencies is a liar or an idiot, because I learned the hard way that corporations, apartment complexes, car dealerships, and credit agencies do not care where your debt came from; they simply care whether you are able to pay it or not. And I'm not. Such is life sometimes.


  1. It is hard to comment because it is so frustrating and unless you deal with it, people just don't have a clue how hard it is!
    I do know that I got a NAMI E-news email and the House passed some legislation on Friday that may help if it gets through the next phase. If you aren't signed up for the E-news, you should sign up. They keep you up to date on what's going on. There is also a place on the NAMI web site to keep up with government news that affects us.
    I am so sad that you have to deal with these cuts and changes. Consistency is so important for everyone but especially when we are dealing with a mental illness. When we find something or someone that "works", it is very very disruptive to have to change.
    My son may not have any coverage by the time TN gets done with the cuts and we are on the second appeal for SS and he couldn't have done that without me and his therapist making him understand that he needs it.
    Oh well, enough said... what you are saying is real and affects so many lives every day. I wish we could get it fixed.
    It is so frustrating!!
    Thanks for sharing.

  2. Thanks, Janet~

    These things are frustrating, and I know how hard it is to get SSDI for many people too. It seems that all social services in this country are constantly being cut back to the point that they no longer meet the goals they should be meeting and they become ineffective. Most people don't seem to realize this until it personally affects them.


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