How to make money off the mentally ill

by Dennis Grace

Recognize the title? It’s from Steve Martin’s 1978 stand-up album, Wild and Crazy Guy. Martin lists How to Make Money Off the Mentally Ill as one of the many books he’s written. The joke is supposed to be on Martin himself, inviting us to ask, “What kind of disreputable jerk takes advantage of the mentally ill?”

But it’s just a crude joke, isn’t it?

According to the U.S. Department of Health and Human Services, from 1996 to 2006 the cost of treating mental health disorders in the U. S. rose from $35 million to $58 million dollars, annually. Clearly, someone in the U.S. is making money off the mentally ill. Such a dramatic increase—nearly double in a decade—would be bad news for victims of any serious medical condition, but it’s even worse for mental health patients.

Why worse?

Well, think about it in personal terms. Most folks don’t consider possible mental health problems when deciding on health care coverage options. Unless we have a family history of mental health problems, most of us think of them as “other peoples’ problems.” We see mental illness and think of delusional folks who can’t fend for themselves. In a minority of cases, that might even be accurate, but modern mental health services cover a lot of far more common, down-to-earth conditions: ADHD, depression, any number of addictions, and PTSD, to name a few. If you decide you have to hospitalize yourself or a family member for mental health reasons—your daughter to keep her from injuring herself, your son to keep him from injuring others, yourself because you’re too overwhelmed to get out of bed—the immediate and long-term consequences can be far more severe than hospitalization for a physical ailment.

In immediate terms, mental health patients are typically locked in for the duration of in-patient care. Even voluntarily hospitalized mental health patients need a psychiatrist’s concurrence before they can leave the hospital. In addition, many mental health hospitals limit quite a few other freedoms that most of us take for granted. Mental health patients typically lose access to cell phones, personal items that have cords and straps, and any kind of blade. If you go to jail, you get your one phone call immediately. Not so if the police take you to the mental hospital.

In immediate financial terms, mental health hospitalization and other mental health treatments are not universally covered by medical insurance programs. Mental health treatment costs—psychotherapy, hospitalization, medication—mount up fast, and insurance, if it covers mental health hospitalization at all, typically covers only 80%. Sure, 80% is a lot of money, but with room and board costs alone being over $2000 per day, a ten day stay is guaranteed to cost over $4000 after insurance. In the long term, those mental health treatment costs keep on climbing. Most patients need a psychotherapist to help them through workable problems and a psychiatrist to manage medication. Patented psychotropic drugs—which might be some patients’ only hope of stability—can run as high as $400 per month. That’s for one medication. Personality disorders often require six or seven simultaneous medications to obtain stability. That’s quite a chunk of change.

For the patients, the stigma attached to mental health problems can be even more devastating than the costs. If my boss finds out, will I lose my job? Will my kids trust me? Will I lose my insurance? Can it affect my credit ratings? And what if a mental health patient disputes the costs of her own mental health care? Doesn’t that just prove she’s being paranoid? Certainly it’s not the kind of dispute a patient wants to undertake during a hospital stay. It is fortunate, (sure, I have a vested interest in the topic) that medical billing advocates are available to take on cases like this to prevent the fleecing of mental health patients. I’m not sure the word has gotten out on that front, though (well, until now).

Mental health is health. Mental illness can be as debilitating as any other form of illness. It can even be fatal. Insurance companies shouldn’t be allowed to decide that one whole category of health deserves the closet.

It’s time to bring mental health coverage into the mainstream.

Dennis Grace is co-founder of MedicalBillDog.com and blogs at The BillDog Blog.

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