Monday, May 3, 2021

Spending Money on Private Care vs Using What Insurance Covers

What most people who read my blog, and honestly most people who know me, don't know, is that I live in an incredible amount of pain. Every day. I can't say every second of the day, but a lot of the time. And it's not just one part of my body that hurts, but many different places. Yes, I have the points that are especially problematic and most likely to hurt, but in general, I just hurt. A lot.

In addition to that, I deal with significant mental health issues. I have written before on my blog about my mental health issues, even though at first I didn't share anything, but I'm really glad I did. But I'm not sure how much people know about how much my mental health issues affect my life and what types of treatment I need. (I'm stable, that isn't the issue...)

Between my physical health and my mental health, I spend a lot of money on my medical care. Add to that what I spend on my kids and their mental health, well, it adds up to quite a lot.

Oh, I forgot to mention that I have national insurance that rarely has copays, and covers all these treatments, and I go privately and pay out of pocket instead.

I've had friends approach me and tell me listen, you don't have so much money, and you have insurance, why do you pay privately for these things? Go with what the insurance has available. They have good practitioners.

The thing is... I've thought about this. Why do I pay privately if I can get things through the insurance company?

Here's the thing.

Where I live there is universal healthcare with their own clinics with all their own service providers. In general, though, the national health service clinics don't pay their practitioners so much money, so many people opt to work privately instead of working for the national health service.

When it comes to mental health, I need someone good. I've asked around to see if there were any good therapists in my area covered by insurance and no one could give me a recommendation. And I am not willing to just go with luck of the draw, because a bad therapist can be worse than no therapist at all. Add to that the fact that while I do speak the local language, I don't do so well enough that I'd feel comfortable doing therapy in the local language. 

Then there's another aspect that because of my diagnoses and my trauma, I need both trauma informed therapists and ones that do specific types of therapy that is needed for people with my diagnosis. When I called up to find out if there was any practitioner through my insurance that did the type of therapy I need, I was told that there is one place in my nearby city, but there is a more than year long waiting list to even have the intake appointment with them. And it is in the local language, not English. So that was a no go. 

Before I got diagnosed and knew which therapy type I needed, I didn't use the service through the insurance because of the language barrier, but I did use a subsidized service through a school (where the therapists are learning a certain modality beyond their initial credentials). However once I got my diagnosis I realized I needed something more specialized and switched to someone private and more expensive. But that was what was needed, because I couldn't wait over a year for a therapist to treat me with the modality that I needed.

However, with all that, it wasn't enough, and a few months ago I started with a somatic therapist, on the recommendation of my psychiatrist and a neurologist, which is supposed to help with trauma that plays out in chronic pain in one's body. There are no somatic practitioners covered by insurance in my region as far as I know. As it is there are very few in my region, private or not, and the ones that are are nearly all fully booked, so this is definitely not something I could rely on insurance for.

With my kids there also was the language issue, which is why I chose someone English speaking, who came highly recommended. And it was urgent, as my kids had gone through a traumatic experience when we first started. She, as a favor, charged me about half of what other therapists charged, but it still was 4 kids that I was paying for their therapy out of pocket. Insurance also would have been problematic because I needed a family therapist specifically because of the situation, and with insurance that wouldn't have been possible, just individual therapy, not someone who treated a family as a unit.

Fortunately right now I don't have to pay as much for therapy, since my eldest gets therapy through his school, and my youngest gets therapy through her school. My second youngest has just started with an art therapist through insurance and I'm hoping she's good, and she is also getting group therapy at school. My younger two do speak the local language, even if not perfectly, so what they get through school and insurance so far seems adequate for them. So that leaves just my younger son. And he needs therapy for something very specific- he got through his school but told me why that wasn't working for him, so I asked around for the best therapist that there is for that specific need, and I was only willing to go with someone who came highly recommended in this area. So yes, this is expensive, because he does not give discounts, but again, a bad therapist can do more harm than no therapist at all.

Additionally, when it came to evaluations for psychiatric stuff for things my kids have needed, I have only gone privately. I had a horrible experience with the clinics through the insurance companies when I tried getting evaluations in the past (did I post about how they reported me to CPS for pursuing a diagnosis they thought my daughter didn't have?) so I wasn't in a rush to go with them. Additionally I wanted someone who fully understood the situation and would help my kid there. I ended up paying for private evaluations 4 times altogether, to the tune of approximately $2500 total, but I felt it was necessary. (To be honest, I was quite upset the last time I went to someone and won't be going back to her because I think she missed a very obvious diagnosis one of my kids needed and ignored the real issue.)

Then for me, I also go with a private psychiatrist. I maintain that a bad psychiatrist is worse than none, and I needed a correct evaluation, and a correct management of my meds, something that I cannot entrust a psychiatrist that I just get through luck of the draw with. So I went to the best psychiatrist in the field, who is an expert on people with my diagnoses, and everyone I know spoke highly of him. Fortunately my insurance covers part of my fees for my private psychiatrist 4 times a year (I recently switched HMOs, but made sure to pick an HMO that covered him). I have only had good experiences with him and would never switch him for a psychiatrist through the public health system.

So that is when it comes to my mental health and my kids' mental health. Which is a big deal and a big part of my budget.

However, when it comes to my kids and my "regular" health issues we generally just use the doctors through our insurance. I can't say I've only had good experiences- I had quite a terrible visit to a neurologist, but overall my experiences have been fine. Same with my kids.

When I had homebirths for my two youngest ones, I paid privately out of pocket for that since my insurance didn't cover homebirths (at least then they didn't, now they started to cover part of the cost of a homebirth midwife, but only after I stopped having babies). 

When I was having some complex issues that I couldn't figure out the cause for them, I paid privately for a functional medicine doctor who could see my whole body as one unit and figure out the cause of the issues. My insurance didn't pay for this type of care at all.

And then the last thing that I pay privately for is physical therapy.

Remember I mentioned that I live in near constant pain? Yea, it really, really sucks. And it is mostly in my pelvic/lumbar region. My mother used to treat me as a physical therapist, but we had a falling out and that no longer is an option. 

My body is quite complicated. My pelvic bones sublux and like to shift completely and extremely, by a few inches at a time sometimes. And that is nothing I can fix on my own. Until it gets fixed I can barely walk, I feel like howling in pain... it just is bad. 

When my pelvis subluxed so completely about 2 years ago I needed a physical therapist badly and quickly and I couldn't wait for the approval process and for appointments to go to a physical therapist through my insurance, so I went to a great physical therapist privately who specializes in pelvic floor physical therapy. I realize now that I was lucky, because pelvic floor PT is about the internal stuff and not dealing with actual movement of the pelvis bones, but she has been a miracle worker there. Hands of gold. 

I went to her weekly for two or three months (literally a week after I started seeing her I had a nasty fall on my bottom which exacerbated all the previous issues and has left me in constant pain since then) but the price was getting to be quite a lot. She told me that if I wanted to go through the health insurance, she had a doctor that she worked with that she could recommend and a competent PT.

I went to this PT for a few months, but to be honest, it wasn't the same, and it wasn't good. The first time I went to him, he literally damaged my pelvis more and moved things out of place that weren't already out of place. Yes, the physical therapist injured me when trying to treat me. That was just a one time thing, but I saw that he really didn't know so much what he was doing when it came to treating me. But then I switched to a different HMO and he no longer is an option for me.

Then I injured my upper back recently and I couldn't move, I was in such pain. I tried getting suggestions and tips on how to make it better, and massage therapist recommended I do a certain stretch to stretch out that part of my back... and as I did that stretch I literally felt my pelvis move out of place.

I needed to go back to the private PT again to put me back into place. Literally my pelvis was a few inches out of place. 

I asked the PT if she knew of a good physical therapist through my new HMO and she didn't have anyone to recommend, since she didn't know that one. But after speaking to her I realized just how tough it would be to find a physical therapist who knew what they were doing with my body. Regular physical therapists and back specialists don't work on the pelvic region and rarely the lumbar region. Pelvic floor physical therapists only work internally. My wobbly pelvis, according to my PT, is actually quite a rare thing, and that would explain why most physical therapists are clueless there. (My mother knows these things since she has the exact same issue.)

After my bad experience with the PT through insurance that was recommended to me, and after following the advice of a massuese who didn't know my body and how normal things that would work for most people would injure me, I made the decision that I cannot trust anyone with my body other than this PT. And yes, even if that means paying privately for physical therapy once a week (at least for now) this isn't something optional. I need to be able to function. I need to have a physical therapist that will be able to help me heal and not someone that will injure me further. And unfortunately that means needing to pay privately.

So yes, even though I have health insurance I pay quite a bit out of pocket for mine and my kids' health monthly. $1850 approximately. But sometimes these things aren't a choice. I mean yes, I could just suffer and have my kids suffer and not be a functional human being. But taking care of my health means that I can actually work and do things to make money as well, which is why I will continue paying out of pocket for my and my family's health, but only in circumstances where insurance just won't cut it. 


  1. Wow- it sounds like a good plan- but so expensive! I’m glad you e found the right caregivers finally.



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