Even When You Do It Right, You’re Wrong: Mental Healthcare In The United States

It was ironic – and not in the Alanis Morissette sense – that I found I was getting screwed over to the tune of almost $800 for my therapy on World Mental Health Day.

Late in the summer, I realized that I needed the help of a therapist again to help deal with some issues in my life. Think of it as "resharpening the tools in the shed"; I pretty much had a good idea of what I was supposed to do, but needed help using the tools more effectively.

As I’ve written about before, the last time I looked for a therapist in real life that my insurance would cover, I ended up talking to a guy whose specialty was working with athletes. It’s bloody hard finding a therapist who you’re able to see outside of the hours that most people work, and it is actively and deliberately made worse by some insurance companies.

So I signed up for BetterHelp (Parent company: Teladoc).

The signup was easy (and this time they didn’t turn me down). I was quickly matched with a therapist who I got along with and was able to help me. The cost – $260 per month without financial assistance – was more than I would pay with my particular plan ($40 per visit to a specialist, so $160/month for weekly visits), but friends who have higher deductibles told me that they could end up paying that much or more for a far less convenient service.

And the service was great. Julie (my counselor) made sure we were on the same page and has been really accessible and invested in how I was doing during the three months that we worked together. She would even send messages making sure I was okay after times when I knew I’d be under stress, and well-wishes when she learned that JDog had died.

One of the greatest things about BetterHelp was that if my counselor and I didn’t mesh, it would have been easy to switch to someone else. This is something that is a huge pain in the rear with IRL therapy. I’ve met waaaaaay too many people who started therapy and ended up with a therapist that they didn’t get along with. The difficulty of finding that first therapist led to them swearing off therapy entirely rather than finding another provider. BetterHelp has effectively removed that problem from the equation.

I found the phone and video sessions extremely helpful. Not only could I schedule sessions outside of normal work hours, but I could literally be in bed and talking to my therapist. I found my sessions with Julie to be far more useful than most of the in-person therapy I’ve done in my life.

But there are problems, and they have to do with insurance and reimbursement.

BetterHelp is billed monthly, not per session, and the receipts say "Subscription" on them.

Obviously, I’ve removed identifying information.

It’s almost impossible to get their service covered by insurance – which they do mention on the FAQ page – particularly since my insurance would require the provider actually writing on some paper forms, which is kind of difficult with telemedicine of any kind.

This did not bother me too much, as I expected my FSA (a way to take some of your earnings and apply them directly to healthcare) to reimburse me for these medical visits. That is, after all, why I put money in the FSA. (If you’re unfamiliar, this is literally money from my paycheck, not the same as insurance coverage.)

What I did not expect was that the FSA (run by PNC Financial Group) to deny reimbursement. The first time they kicked it back, I was told that I needed actual dates of service to be specified instead of a "subscription". Then, when I submitted three months worth of claims along with dates of service (and screenshots showing that the service occurred), they said that was insufficient as well, due to the lack of an itemized receipt.

When I asked BetterHelp for a receipt showing either the dates of service or removing the word "subscription", I was flatly told no.

There is no way to actually get in touch with BetterHelp other than e-mail, so trying to actually reach someone for comment was impossible. The number listed on the receipt above only goes to an answering service. They are located in an (apparently) industrial park in California, but getting more information is extremely difficult.

As of the time that I’m writing this, BetterHelp has yet to respond further.

I don’t really know who to blame here. Maybe everyone. It is already difficult to get therapy appointments in real life. Insurance companies are making it harder. There are mechanisms to pay for medical services that people are encouraged to use – like FSAs. Telemedicine is touted by many people as helping to improve access to healthcare (mental and otherwise). But, due to paperwork restrictions – the existing mechanisms of insurance and FSAs will not pay for telemedicine, meaning that if you don’t have the cash to pay for it entirely out of pocket, you will be quite thoroughly screwed.

We have come a long way since I wrote "I Listen To Them Snicker" twenty years ago. But with current (literally as I’m writing this) headlines like "Cut To Oregon State Hospital Wait Times Leaves Some Without Mental Health Care" and "Pa.’s largest community college eliminates campus mental health counseling for 17,000 students" and "Mental health sick leave rises for emergency workers" and "Rural First Responder Access to Mental Health Care: A National Crisis" and "Mental Health Is A Leading Cause For Why People Are Quitting Their Jobs—Here’s What You Need To Do Now" there is clearly a need for better access to mental healthcare.

But with the bureaucratic roadblocks that insurance, financial institutions (like PNC), and even the providers themselves have put in place, the promise of increased access is simply an illusion, only available to those affluent enough to afford it.

And that is just fucking insane.

Featured Photo by Sydney Sims on Unsplash