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.

insurance

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.