The U.S. (mental) healthcare system is infuriating.
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The U.S. (mental) healthcare system is infuriating.
I had to seek mental healthcare for my college-aged kid. They already have a mental health provider, but that provider recommended a service they don't offer themselves. This meant we had to:
1. Wait for the mental health provider to do whatever they do behind the scenes so my kid's PCP could actually make the referral.
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2. Call our insurance company to see if the service is covered. (It is, as long as we go to an "in-network" provider.)
3. Wait for the PCP's office to send a long list of outside practices that offer the service, since it's not available within our provider's practice.
4. Cross-check the list of practices with our health insurance online database of "in-network" providers.
- Some practice websites helpfully listed the insurances accepted, but not all.
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2. Call our insurance company to see if the service is covered. (It is, as long as we go to an "in-network" provider.)
3. Wait for the PCP's office to send a long list of outside practices that offer the service, since it's not available within our provider's practice.
4. Cross-check the list of practices with our health insurance online database of "in-network" providers.
- Some practice websites helpfully listed the insurances accepted, but not all.
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- Some practices are included in the insurance database, while other practices are not listed BUT at least some - not all - of their individual providers are.
- This whole process meant going to practice websites, looking first for insurance information, then, if necessary, looking for a "Meet Our Team" page, and looking up individual names on the health insurance website.
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- Some practices are included in the insurance database, while other practices are not listed BUT at least some - not all - of their individual providers are.
- This whole process meant going to practice websites, looking first for insurance information, then, if necessary, looking for a "Meet Our Team" page, and looking up individual names on the health insurance website.
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More than half of the list was eliminated because they don't take our insurance.
I prioritize the remaining options based on:
- Geographic proximity
- How clearly their website says they offer the desired service
- Ease of navigating their website5. Call practices for an appointment.
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More than half of the list was eliminated because they don't take our insurance.
I prioritize the remaining options based on:
- Geographic proximity
- How clearly their website says they offer the desired service
- Ease of navigating their website5. Call practices for an appointment.
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5a. The 1st place had a recorded greeting instructing me to leave a message, further advising that if I don't get a call back within 3 business days, that means they have no availability.
Like a teenaged girl of yore waiting for a boy to call, I stayed close to my phone just in case. I did not get a call.
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5a. The 1st place had a recorded greeting instructing me to leave a message, further advising that if I don't get a call back within 3 business days, that means they have no availability.
Like a teenaged girl of yore waiting for a boy to call, I stayed close to my phone just in case. I did not get a call.
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5b. The 2nd place had a recorded greeting instructing me to go to their website & fill out their online form. I do so.
They respond the same day by email! I reply expressing interest in moving forward.
The next day they send an email explaining that the desired service is only offered in conjunction w/ another service (which we don't need) & since the OTHER service is NOT covered by insurance, we would need to pay almost $3,000 out of pocket.
I decide to keep looking.
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5b. The 2nd place had a recorded greeting instructing me to go to their website & fill out their online form. I do so.
They respond the same day by email! I reply expressing interest in moving forward.
The next day they send an email explaining that the desired service is only offered in conjunction w/ another service (which we don't need) & since the OTHER service is NOT covered by insurance, we would need to pay almost $3,000 out of pocket.
I decide to keep looking.
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5c. The 3rd place had a recorded greeting leading me to believe I might actually get to speak with someone if I "stay on the line" - but alas, no, after a dozen rings I was sent to voice mail. I left a message.
I received a return call later the same day. She was very kind but told me they no longer offer the desired service.
5d. The 4th place had a real live person answer the phone!! She was also very kind but also said they no longer offer the desired service.
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5c. The 3rd place had a recorded greeting leading me to believe I might actually get to speak with someone if I "stay on the line" - but alas, no, after a dozen rings I was sent to voice mail. I left a message.
I received a return call later the same day. She was very kind but told me they no longer offer the desired service.
5d. The 4th place had a real live person answer the phone!! She was also very kind but also said they no longer offer the desired service.
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At this point, I literally cried in frustration.
5e. The 5th place (with the most unwieldy website) is where I should have started. I guess don't judge a medical practice by their website.
️A real live person answered the phone! They do offer the service! But alas, since my child is technically adult-aged, they would not allow me to make an appointment.
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At this point, I literally cried in frustration.
5e. The 5th place (with the most unwieldy website) is where I should have started. I guess don't judge a medical practice by their website.
️A real live person answered the phone! They do offer the service! But alas, since my child is technically adult-aged, they would not allow me to make an appointment.
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6. I fret over the idea of my kid having to manage the new patient phone call themselves because it is a non-trivial task and exactly the type of thing for which they are being referred to this service in the first place.
Luckily, my kid gets a school holiday for Presidents' Day and would be home from college for a long weekend. I call the practice again and confirm that they will be open on that Monday.
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6. I fret over the idea of my kid having to manage the new patient phone call themselves because it is a non-trivial task and exactly the type of thing for which they are being referred to this service in the first place.
Luckily, my kid gets a school holiday for Presidents' Day and would be home from college for a long weekend. I call the practice again and confirm that they will be open on that Monday.
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7. We call together to make the appointment. They tell us how my kid can give permission for me to make appointments for them in the future.
From beginning to end, the entire process took almost a month, and the initial consultation appointment is a month away.
I'm just a mom trying to get mental healthcare for my kid, and I think that was TOO many hoops and hurdles for an average person seeking mental healthcare to have to navigate!!
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7. We call together to make the appointment. They tell us how my kid can give permission for me to make appointments for them in the future.
From beginning to end, the entire process took almost a month, and the initial consultation appointment is a month away.
I'm just a mom trying to get mental healthcare for my kid, and I think that was TOO many hoops and hurdles for an average person seeking mental healthcare to have to navigate!!
/end
@ikuo1000 I'm sorry. The system is awful. Your kid is very lucky to have a mom who is willing and able to help with the legwork. My heart breaks for all the people who fall between the cracks because they don't have anyone to help them with the endless phone calls and research.
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@ikuo1000 I'm sorry. The system is awful. Your kid is very lucky to have a mom who is willing and able to help with the legwork. My heart breaks for all the people who fall between the cracks because they don't have anyone to help them with the endless phone calls and research.
@Lkdc Thank you!
And right?!? If my kid - who is technically an adult and expected to handle such things themselves - actually had to do all that legwork themselves, most likely it either simply would not get done, or else they would have a mental health spiral in the process! As you say, I really feel for those who don't have assistance.
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7. We call together to make the appointment. They tell us how my kid can give permission for me to make appointments for them in the future.
From beginning to end, the entire process took almost a month, and the initial consultation appointment is a month away.
I'm just a mom trying to get mental healthcare for my kid, and I think that was TOO many hoops and hurdles for an average person seeking mental healthcare to have to navigate!!
/end
@ikuo1000 You are basically doing the job of a referral coordinator, but some practices don’t have that staff person. It really is a full time job. I’m so sorry you had that many obstacles to get a mental health referral for your son. It should never be like that, but it’s more of the norm now instead of the exception. US healthcare system is so broken. Every day it’s a disappointment.
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@ikuo1000 You are basically doing the job of a referral coordinator, but some practices don’t have that staff person. It really is a full time job. I’m so sorry you had that many obstacles to get a mental health referral for your son. It should never be like that, but it’s more of the norm now instead of the exception. US healthcare system is so broken. Every day it’s a disappointment.
@huskify A "referral coordinator"!
That was the title of the person who gave us the list of outside practices, which ended up being outdated - not only did some places not offer the service, but multiple phone numbers were incorrect too. 
I feel so sad that life has gotten so much harder, not easier, as I've aged. It feels like the enshittification of real life, where nothing is straightforward, everything must be "navigated", and if things actually go smoothly it's a shock.
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@huskify A "referral coordinator"!
That was the title of the person who gave us the list of outside practices, which ended up being outdated - not only did some places not offer the service, but multiple phone numbers were incorrect too. I feel so sad that life has gotten so much harder, not easier, as I've aged. It feels like the enshittification of real life, where nothing is straightforward, everything must be "navigated", and if things actually go smoothly it's a shock.
@ikuo1000 It’s called sludge
. Good article on customer service today in the Atlantic: http://archive.today/XrBiB -
@ikuo1000 It’s called sludge
. Good article on customer service today in the Atlantic: http://archive.today/XrBiB@huskify Wow! What an article. Omg. I feel so seen. Thank you so much for sharing it!!
This part is exactly what I fear, that people are so beat down that they give up trying to get what they are legitimately entitled to:
"When I started talking with people about their sludge stories, I noticed that almost all ended the same way—with a weary, bedraggled Fuck it... I came to see this as a permanent condition. We are living in the state of Fuck it."
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@huskify Wow! What an article. Omg. I feel so seen. Thank you so much for sharing it!!
This part is exactly what I fear, that people are so beat down that they give up trying to get what they are legitimately entitled to:
"When I started talking with people about their sludge stories, I noticed that almost all ended the same way—with a weary, bedraggled Fuck it... I came to see this as a permanent condition. We are living in the state of Fuck it."
️@ikuo1000 OMG. Just read this too. Exactly your son’s case! https://www.propublica.org/article/emblem-health-ghost-network-settlement-mental-health
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7. We call together to make the appointment. They tell us how my kid can give permission for me to make appointments for them in the future.
From beginning to end, the entire process took almost a month, and the initial consultation appointment is a month away.
I'm just a mom trying to get mental healthcare for my kid, and I think that was TOO many hoops and hurdles for an average person seeking mental healthcare to have to navigate!!
/end
@ikuo1000 I'm so impressed you managed to get an appointment at all.
When my kid was in high school, I spent a month calling and ended up with a place on a waitlist. Six months later, I called to check and was told that their position on the wait list hadn't changed and it would be at least a year. Three months later they eliminated the wait list without seeing anyone - just called and told us it wasn't a thing anymore.
The whole process was like having skin scraped off a little piece at a time.
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