before we get started....
Terms to Know (In Order of Appearance in Text):
SSI - Supplemental Security Income. It’s a federal welfare program catered to the elderly (over 65), the blind, or, in my case, the disabled
SSDI - Social Security Disability Insurance
SSI vs. SSDI - The first deals strictly with financial need. The latter deals with work history—your prior earnings before becoming disabled. And after 2 years, the recipient is eligible for Medicare (also defined below)
Medicare - A federal health insurance program that provides benefits to both seniors and those with disabilities and certain illnesses. It comes in several parts, 3 of which pertain to my situation:
Gold Card - Now known as the Financial Assistance Program provided by the Harris Health System that charges patient on a sliding scale based on their income and other criteria. There is no physical Gold Card and I have no clue why they used to call it that.
Psychiatrist - A doctor that specializes in treating the mind by prescribing medication. Different from a therapist—see my blog post about Therapist Vs. Psychiatrist
Deductible - An amount to be paid out of pocket for healthcare services before insurance starts paying for anything
Copay - Short for Copayment. Payments that are charged when a deductible has been met
EOB - Acronym standing for Explanation of Benefits. A statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf
Dartmouth Medical Withdrawal - A process that a student goes through after leaving the institution for medical reasons. During the withdrawal process, the student has to complete a certain criteria in order to return to campus and resume studies.
How I Stepped foot into the Medical/health insurance world
Welcome to My World!
Another day. It’s 7:30 AM and I just got off the phone with the Social Security Office. Because they are only so many slots available for in-person appointments, the representative on the phone was unable to schedule an appointment for me. I will have to wait to get a phone call directly from the office within a week (hopefully), or rise early to call the Social Security number again. Early bird definitely gets the worm, while late bird has to wait anywhere between 30 minutes to 2 hours to talk to a representative on a call to Social Security. They recently added a call-back feature, which has made waiting less stressful.
But this is a normal day for me. I am used to waiting hours, days, and even months to be approved for a program or face rejection from them for whatever reason. As I placed my phone down and began to write this very blog post, I realized that I not only wanted to talk about the Medical World and Health Insurance, but also tell my story and how it relates to it all. So here we go!
How It All Started: My Journey into the Medical/Health Insurance World
Health insurance is a pretty complicated and sensitive topic. My goal in this post is to open up about my own healthcare situation and try to simplify complex matters, just like I did in my post about my own illness. When I first left Dartmouth on Medical Withdrawal, I was insured by Cigna. I had no idea at the time, but Cigna is "one of the best-known health insurance companies in the United States, with a large network of over 500,000 physicians and more than 8,000 hospitals in its network." (Source: Consumeraffairs.com) And the best upside is that consumers can choose a variety of plans, including low-cost offerings.
When I was first hospitalized, I was at the DHMC (Dartmouth-Hitchcock Medical Center) in Lebanon, New Hampshire. I remember receiving many visits, but one particular visit stood out to me. A big, tall man approached me one day and asked if I had insurance. “Yes, I do,” I replied, not really knowing whether I did or not. That same evening, a patient was arguing with the medical team about what they should do with him since he did not have insurance. He seemed like he was in a tight situation, but I didn’t quite understand it. Not yet, anyway.
Time would pass and my hospitalizations would continue, all while being under Cigna. I never had to worry about having to leave the DHMC.
Once I did leave the DHMC, I was not allowed to stay on campus for long. They arranged a taxi ride for me back to the Boston Airport. It was a long and weird ride. The driver mentioned to me that sometimes life does not go as planned, and we have to work around it. But why was he giving me that sort of advice? I wondered. What is going on? Am I leaving Dartmouth forever?
So there I was, back in Houston with detailed instructions on how to get back to Dartmouth. Never mind the fact that I was embarrassed to mention to my family members that I had experimented with both fake marijuana and LSD and that I had just been diagnosed with a chronic mental illness—I was in further denial than The Nile River! But I was determined to go back. So I followed my list and it pulled me through:
The journey was not easy, though. Back home in Houston, I began to really learn more about what my medical insurance could (and could not) do for me. I did not understand the difference between a copay and a deductible, and since I was used to getting everything for free, I was visibly frustrated when the workers in the medical office would name a price and expect me to pay it. I looked at them like they were crazy! I once saw a sheet that listed almost every possible mental disorder you could imagine—along with a number. A number that told you the price of seeking treatment for that particular disorder. I must admit, I was relieved at how “affordable” my illness was.
But I did not understand that it was typical to see a psychiatrist for less than 30 minutes and talk with a therapist for over an hour. I remember sitting across from the psychiatrist as she set her glasses down on her desk and told me: “Look, we don’t really know what Bipolar is. You will probably deal with this for the rest of your life. And just like medicine for high blood pressure or Diabetes, you have to take this.” These were shocking words to hear for a 19 year old who was doing just fine at an Ivy League school and now somehow landed herself in a doctor’s office she had to catch 3 buses to arrive to. I was still a young student back then—jobless (except for work-study), carless (in the big city of Houston!), ignorant, and innocent. The meeting with my first therapist was worst. Sitting alone with her in a dark room, she told me the story of her daughter who had transferred from nearly 3 different schools. “Do you [even] like Dartmouth?” she then asked me. I felt very offended by the question. Was she implying that I was not happy there, and that I would be transferring from school to school too? I hated the thought of the “T-word,” and I hated that therapy session. I did not understand why I needed a therapist in the first place, and I felt like she was prying in my life. Non-surprisingly, she kicked me out of her office.
Thus began my search for a decent therapist.
I needed a therapist that was going to write my fit-for-exam, or my letter that would document my improvement so that I could get back to Dartmouth. I remember searching desperately online for anything that was free, but the World Wide Web can be a deep sea or confusion when you don’t know how to look for what you’re looking for. When I finally stumbled upon Greater Houston Psychiatric Associates, I was relieved that I would only have to catch one bus to get there. But I was surprised that I had to make a “down payment” of over a hundred bucks for my appointment. I just paid what I could. I had to get my list done. The team at Dick’s House helped the best they could from afar, but I was basically swimming in my own boat. And I couldn’t find the paddles anywhere!
Then came the frequent hospitalizations.
While I was hospitalized in Houston, I went to the Bellaire Behavioral Hospital. It was a very nice facility; patients were separated by level of recovery and gender. The food was decent. I even attended outpatient twice. Not once did I worry about the price. When I did receive EOBs in the mail, they never really made sense to me. And as far as bills were concerned, I simply didn’t pay ‘em!
The Terrible Case of the Revolving Door Pattern
By 2017, I had resumed my studies at Dartmouth and had completed the medical withdrawal process with "flying colors." I was doing so well that I no longer believed I had Bipolar Disorder (big mistake), and I stopped takin my meds. I fell into relapse during the summer of that same year and was sent home again. This time I had purchased my own car while in New Hampshire. With very limited driving experience, I went on my first unexpected road trip from the east coast all the way back to Texas.
My mom always tells me that Dartmouth was “tired of paying for my manic episodes,” and that’s why my insurance was dropped. The reality was that I was on medical withdrawal for so long that I was considered an inactive student, and inactive students are not eligible for insurance since they are, well, inactive. By 2017 during my SECOND medical withdrawal, this really hit me hard. I could no longer see the therapist that I was seeing under Cigna and had to find a therapist through the Harris Health System.
I started on my list again.
And again...you get the point!
I eventually did get a steady job in 2019, and although I truly believe they were underpaying me, I was just happy to find something productive to do with my time. But then my Gold Card expired. When I renewed my financial assistance application, I was placed under a new plan, the self-pay plan, with copay that was no longer under 5 bucks:
You read that right. $95. This may not seem like a lot to some people, but for someone who was used to paying little to nothing for health services, this caused a drastic change in my life. I was no longer able to afford therapist sessions twice a week, or even a therapist entirely for that matter. I resorted to only seeing my psychiatrist. I was in the process of applying for Medicaid without SSI, but they denied me because I was not "with child." It got to a point where I honestly considered getting pregnant to get health insurance. It should never have to come down to that!
The Bright Future is, Well, Bright!
But There’s hope! I am making another effort at applying for SSI. With SSI, I will get Medicaid. Right now I am just a student and only a student—I am not working at all. If I decide to work, there will most definitely be an income threshold. I’ll have to wait a long time on the phone for the in-person appointment, which will also entail me waiting for a long time in a long line on a long day, but I will not give up!
The first time I had an in-person appointment for SSI, I was rejected because I did not provide a form that proved that I supported my mom, a criteria for getting SSI. I was not even aware of the form! Once I got over the frustrating emotions of unexpected unpreparedness, I decided to give the Social Security Office another ring.
The rejection was not all that bad. I actually learned something: I’ve never received benefits for my own disability. This whole time, I’ve been getting benefits because my father had a physical disability. My father died when I was 7, so I never got the chance to ask him what his physical disability actually was, or if he might have had a mental one as well. Family members can only provide clues, but I’m afraid it’s a puzzle that I cannot solve for now.
Anyway, here’s what SSA.gov says about my situation:
I was diagnosed with Bipolar Disorder when I was 19 years old—can you believe it? Nearly 6 years ago! I guess it’s now time to really get benefits for my own disability, not my father’s.
Navigating the healthcare system has not been easy at all, but I have truly learned a lot along the way. As I wait for my next SSI appointment, I prepare to see my new psychiatrist on the 11th of this very month--it's only a few days away! Stay tuned for a future blog post on my visit with my NEW psychiatrist!