• August 28, 2014

Depression doesn’t play favorites, but insurers do

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Posted: Wednesday, April 30, 2014 4:30 am

When I wrote about depression three months ago, I was still, for the most part, in the throes of it. Happily, with time and distance comes more perspective — some good, some not-so-good.

I was overcome by the amount and quality of responses I received to that column. It seems that everyone knows someone who has dealt with depression. And yet, the experience still feels foreign and shameful for those of us going through it.

In early January, I went to see a counselor because I couldn’t find a reason to get up in the morning. Even things that used to make me smile — finishing a knit hat, going to my kids’ school functions, eating dinner as a family — brought nothing. I felt hollowed out and flat. Worse, I couldn’t stop crying, and I didn’t know why.

I reached out to the counselor in a moment of desperation. My boys started to recognize that something was wrong, and with my Navy husband gone so often, I am their constant. I could see the worry in their eyes.

The counselor saw me as often as needed. I think I went every day that first week. I clung to my appointment times like little islands of hope.

It was only later that I learned my insurance, Tricare, doesn’t cover that particular counselor. In a moment of despair, I had reached into the yellow-pages grab bag and picked the wrong name. By then, however, it was too late. The counselor and I had already covered so much ground. She was helping me get better. How could I start over?

Tricare offered no solution, except for me to see someone else 90 miles away.

This is a horrible flaw in the industry’s view of mental health. When someone is having a heart attack, they don’t call around first to see who their insurance will let them see. No, they get to the emergency room and sort it out later.

Likewise, when someone is suffering from depression, they usually don’t have the clarity to wade through jargon and complicated phone trees to figure out which counselor they can see. If we’re lucky, these people pick up the phone, call a counselor and say, “I need to talk to someone.”

Also, mental health services are unique in that they require a deeply personal, working relationship between the provider and patient. Just because Tricare says I should see counselor X doesn’t mean counselor X can help me.

In the end, my husband wrote a big check for all those appointments I had while in crisis mode. (If I’d had emergency heart surgery at the “wrong” hospital, would Tricare refuse to cover it afterward?) And now I’ve quit going to counseling, partly because I’m doing so much better, but mostly because I never could figure it out with TriCare, and paying 100 percent is too expensive.

How many other people out there are in the same situation, only they are still suffering?

Another thing I learned during this time was how people’s perceptions of me changed by my condition. There were other people in the waiting room when I arrived at a large local hospital to get my medication.

We were all from different socioeconomic starting-points, but we were at the same finish line, with weary bodies, tear-stained faces and wearing yesterday’s sweatpants.

When a woman from the insurance department came to talk to me, I noticed she was wearing a Talbot’s dress.

I had seen it at Talbot’s just two months earlier, back when I did things like get dressed.

Two months ago, I might have mentioned the dress to the woman. But not that day. We didn’t have the same rapport we might have had another time. I had slipped into a different category. It was “us” and “them.” I was “us;” she was “them.”

In March, I returned to the same hospital for a follow-up appointment. I was feeling better now, thanks to anti-depressants, and it was like a curtain had lifted. I was out of my sweat pants, and I had curled my hair. I smiled at people. I was participating in the world again.

I had come through to the other side, and I couldn’t wait for my appointment to be done so I could get on with my life.

As I drove away, I was excited about a new hat I would finish knitting for Owen that night.

I felt joy.

But I still think about the people I left behind in the waiting room, the ones whose curtains remain closed. That’s the humbling part about depression. Once you’ve been throughout it, you know: we are all — Talbots dress or not — one crisis away from being in the waiting room, answering to one of “them” who won’t look us in the eye.

And we’re probably going to pay out-of-pocket for it later, too.

Sarah Smiley is the author of “Dinner With the Smileys,” a memoir of a year of dinners and motherhood.

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1 comment:

  • mbcooke posted at 5:40 pm on Thu, May 1, 2014.

    mbcooke Posts: 1

    Sarah you are so right, for counseling to work, it does require a deeply personal connection, especially for treating depression. Congratulations to you for going public with your story, for I feel sure someone else is reading this who will feel comforted that he or she is not alone. There are many practitioners in the Killeen, Temple, Belton, Georgetown area that will see you for a "sliding scale" rate especially for military family members (I do in mine). With Mary Hardin-Baylor University and Texas A&M Central Tex. right here, there are also very fine interns who are trained to help people such as yourself. We need to do better at many things, including getting the word out on where to go for affordable help. Thanks for the article, Mary Beth Cooke, LMFT, LPC, Georgetown

     

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