I’ve now been unemployed for 19 days. I wrote earlier about giving up my very interesting but insanely demanding job in the hopes of improving my mental and physical health. But the irony is that in giving up the job, I also give up the excellent health insurance that was one of the benefits of the job. Health insurance to cover the physical and mental health needs made worse by my serious job burnout.
So I’ve begun exploring health insurance options on the federal insurance exchange. I’m glad there is an exchange–not so many years ago, as an individual with a history of mental illness and self harm, don’t even know if any company would have agreed to insure me. I’m grateful for the Affordable Care Act and that there are options. The options themselves, however, are not that impressive. In fact, they are kind of alarming.
As I feel the anxiety starting to kick in, I respond with my usual coping strategy. Let’s get analytical about this. I open up Excel and build a spreadsheet that compares my out-of-pocket cost under different scenarios. What would be the cost for the rest of 2016 if I am mostly healthy but need to spend the night at the sleep lab? What will be the costs next year if I use services more or less at the rate I did in 2015? What if I need multiple follow-up appointments with my urogynecologist? What if my prediabetes becomes diabetes? And especially important, what if I don’t want to stop seeing E, the therapist with whom I have worked off and on for more than a decade? Of course, she is not on the list of preferred providers for any of the insurance plan options I have reviewed so far. I need to call her bookkeeper and find out what insurance company she is on the list for.
So far the most affordable insurance option I found (one that still provides coverage for the kinds of things I need coverage for) would not pay any part of the cost of seeing E. After a deductible, they will pay 80 percent of the cost of providers on their list and nothing for those not on their list. The list is all social workers and a couple of psychiatrists. No PsyD clinical psychologists, which is E’s background. And maybe that is fine; I don’t know. But the idea of starting all over again with someone who doesn’t know my history… I honestly can’t imagine it. I think I’d rather not have any therapy at all, if that were my only option.
Admittedly, I’ve not had the easiest time with E this summer. A lot of it has been my fault, but she did make some things worse by going off on her existentialist track and also by sometimes truly not seeing what I was going through. But she’s human, and she’s also been there for me many, many times. I feel she is cooler to me than she used to be, and I regret ever showing her my aggravation with her. I do feel I lost something that hasn’t come back. Nevertheless, even with these issues, she means so much to me. My younger parts, in particular, longs for her. I feel safe in her office. I like that I have known her for a long time.
That same most affordable insurance option (okay, it’s Kaiser, which explains why I couldn’t continue with any of my current doctors) also would not allow me to follow up with the gynecological surgeon who performed my hysterectomy and cut and patched and sewed my vagina this past spring. At some point I’ll probably write about this more, but for now, suffice it to say that I have some lingering issues from that surgery. I’m supposed to go back and see the surgeon next month, when she gets off her maternity leave. But if I switch to Kaiser, I won’t be able to afford to see her.
Then there is my primary care physician. I just switched to her last fall, and she is the first primary care doctor I have had in years that I have liked and mostly trusted.
As I write this, I realize it is probably worth focusing on the most affordable option that would allow me to keep the doctors that I have. Because while the cost is definitely worrying me, it’s the idea of starting over with all new health care providers that bothers me the most. When I think about everything I went through to let my gynecologist know that I had an abuse experience and needed her to slow down and be more attentive to my experience… That’s another experience I’d rather not repeat.
Looks like I’ll be busy with that Excel spreadsheet and online lists of preferred providers for another few days.
P.S. To anyone inclined to say, “Why didn’t you think about this before you quit your job?” the answer is: I did think about it. I worried a lot about giving up a quite decent salary and excellent health insurance as well as dental and vision coverage and life insurance and a 14% contribution to my retirement account. However, I could not keep working like that. I couldn’t. What would be the purpose of that income and benefits if I either had a heart attack or committed suicide? It’s a crappy trade-off though: a less stressful life, but no resources to recover from everything the stress helped do to me.
Sage Burning 
I could have written this post! It will all work out. I did the opposite of you. Figuring I am mostly healthy and won’t go to the doctor. The money I save every month goes towards seeing integrative practitioners who aren’t on any insurance panels anyways. I’ve always paid out of pocket for my T because she is NOT on any insurance panels. Guessing I’m lucky to be healthy. Come December I will probably look into better insurance (just in case) but for now this works.
It’s an okay trade off. I think if you had stayed in your job that it would have continued to make you unwell. You have permission to rest. 💜
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Hi,
When I was on the ACA, I picked the plan with a lower premium, figuring I was paying out of pocket for my providers mostly and the plan really just was for something serious. I did all the math and discovered those actuaries do a really good job – my costs were going to be roughly the same, there were a few wrinkles based on my family’s spend that made one plan more advantageous than another. at the end of the day, I could spend the money on the premium every month or on the providers via a high deductible. I was going to spend either way. Even if they don’t cover the provider, in my state, they counted towards the deductible. So I went with the high deductible.
If you exceed the income limits for a subsidy, you may also want to consider a HSA plan. They have lower maximum out of pockets and are more friendly in some ways.
Another option, it seems you have lots of grant-writing experience. Have you considered doing consulting? Many non-profits will pay for a good grant-writer that don’t have one in-house but is not like the stress of a regular job. I have done this. A few bursts of stress, but not the day-in and day-out. and can help with expenses. I am even not really a grant-writer. But because I had written grants that got funded, I found a client who just called me whenever they were writing a big grant.
I don’t write much but always read so hope its okay to offer my thoughts.
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Hi Melissa, thanks so much for writing. It’s very helpful to know what other people have decided about health care options.
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Oops, hit send by accident. I was going to ask, what is HSA?
And yes, I have been thinking about consulting. I can write grant proposals, which, as you say, can be short-term rush and stress but then that’s it. And I have a lot of experience. I have also thought about other ways I can use my research experience to consult. But I think I am going to wait until November or so to look for opportunities. I can feel my stress is better than it was in August, but all that anxiety and self-loathing is still very close to the surface. It wouldn’t take much to set them off again!
Thanks again for writing.
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Health Spending Account. You can put money in a health account and then roll it over year to year if you don’t use it to pay for your deductible and out of pocket expenses.
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That’s not a bad idea. I will add another option column to my spreadsheet, one that goes minimum on premiums and instead puts funds into out-of-pocket things I think are most important: E, massage, and work with the mind-body therapist. Although, since I haven’t been very healthy this year, it does feel a bit risky.
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This post gave me a lot of insight. I live in a country where we are covered regardless and I pay out of pocket for A… But that’s a choice. I’m grateful for that choice. Wishing you luck.
And also – nobody has the right to judge your choice. You made the right one for you and that’s all that matters.
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I know, the U.S. system of primarily linking health care to employment is messed up! It is one more way of keeping us yoked to our jobs, also another way of stratifying society. People with professional jobs get insurance and good coverage. People with more working class jobs get inadequate insurance, or premiums take up a big chunk of their budget. People with disabilities are theoretically entitled to state-paid insurance, but don’t get me started on the issues with that! One of my sons has autism and sometimes has this insurance (sometimes things get messed up and he’s uncovered for a while). When he has it, it’s still a huge amount of work to find a medical provider who will accept Medicaid because it underpays doctors and has complicated record-keeping requirements. Obama helped move the medical insurance system forward a bit, but there are still mountains of problems here that need to be addressed.
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I think the trade off is okay, too. You needed to be out of a job that was making you sicker. I do know the pain of dealing with buying private health care. Although we get coverage from hubby’s work, a few years ago, he removed Kat and I for his insurance and we bought private so we would have autism therapies coverage. We paid private insurance for a year and spent the year lobbying his company to adopt coverage– which they did! But choosing the best insurance was hard. I went through the the same struggle as you– what would be cheapest but allow me to keep our current doctors and provide autism coverage? Ugh. Sending you lots of positive vibes and hugs and hopes that you find the best insurance for you. Xx
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I’m glad you found coverage that provides services for Kat. When my son was diagnosed with autism (late 90s), the conventional wisdom was “there is no cure for autism, so the insurance company does not need to pay for any therapies.” Isn’t that disgusting? A few years later we could get him some therapy and meds for his anxiety and ADHD, but still, nothing for autism.
Thanks for the good vibes and hugs and hopes. I will draw on them as I continue to put numbers into my Excel chart!
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I’m fortunate to live in the UK with our National Health Service. I pay out of my own pocket for my therapist because I found that the “free” services just weren’t working for me. I dont really understand all the health insurance stuff having never had to use it. It sounds like a nightmare.
You need to make decisions based on what is best for you. You are not required to have to justify your choice!
I completely understand having to leave a job that is too stressful for you. I’m currently in the situation myself where I am wondering if I’m better off leaving my job and just trying to get my head together… It’s all so hard.
Thinking of you xx
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Yes, it’s a really big deal to choose health over a job, not because we doubt the value of health, but because it’s not easy to give up co-workers, an identity, a daily structure, and of course, the salary. And over here in the U.S., also insurance and a retirement account (do you have privately funded retirement in the UK too?). A very big price for mental health. I am pretty confident it is the right choice, but this week I am really feeling the price.
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We have a government funded retirement but it isn’t much. They are now slowly introducing a private fund which you pay into and your job pays a percent as well. It all gets a bit confusing. To be honest I don’t really pay a lot of attention. I find it very hard to look ahead to the “future” I have enough of a problem with the present. Every day is a battle and the only way I get through is to take each day as it comes.
Always do what’s best for you at the time Q 🙂
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This is really stressful, Q. I can understand why there would be lingering judgments and doubt about your decision, with the reality of our inadequate healthcare system sinking in a little more. And how those voices could use this situation to further distance from E. A lot here to process, glad you are writing it out and sharing.
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Thank you for getting it. I do want to be alert to the doubting voices undermining my relationship with E.
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Stick with the programme! I can understand and relate to what you say. I threw myself of the cliff from a very well paid position in the UK. Since then, yes, I’ve struggled financially. But I would never go back to the life I had before…
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Oh, thank you for saying that, Serena. It helps to know I am not the only one who made that choice. Did you completely change the field you work in, or what did you do after quitting?
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Ugh – sounds difficult. But I think you did the right thing in quitting and setting out on a new path, for what it’s worth. I wonder what reader here would actually say or think the horribly critical thing you imagine?
I’ve been following along, and I doubt that E’s feelings for you have actually changed. I think it may be more likely that your own feelings have changed. I’m saying this based on my own experience though, of course. For me, I went to group therapy for two years, led by my T, and I found it horribly tough. I became convinced that he no longer cared about or liked me. He kept saying his feelings for me hadn’t changed, but I could not believe him.
Once I stopped going to the group, slowly, I got perspective and started to see that I was triggered in the group, and that he was the same person he had been before I went to it, and that he still cared about me. It was a real journey for me though. The feeling that he no longer liked me was so very strong, I couldn’t believe it wasn’t reflecting facts at the time.
I suspect you would need to keep showing E your honest feelings to make progress in this department though.
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Sometimes I think you are right, and the whole thing has been my own insecurity. I’ve deliberately looked for things that I could label as evidence that she doesn’t care, while also downplaying all the evidence that she cares. But then something will set me off again, and I’m back to the place of longing for her and being sure she doesn’t or can’t care. I am stuck on this issue. Obviously.
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I’m not sure I’d call it insecurity exactly, seeing as this is a therapy relationship. And insecurity is a bit of a judgy word. I think it is more of a memory of other attachments which went badly. That’s how I understand my own feelings, anyway. BTW, if this is your issue, stay with it as long as you need. It may shift for you if you can stay with it long enough, as my T would say. It seems like it’s important.
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You and your health are so worth the cost, Q. And I say that as somebody who spends $200 a week on therapy, so I do have some idea of the frustrations and challenges of devoting a huge portion of your budget to mental health. It sucks, and I wish that wasn’t how it is for either of us. And I’d encourage you to call on support, if you can – if you have family with financial resources who could help you out, or if your husband could pick up some more work to help with costs. Don’t try to work it out all alone if you don’t have to.
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