What can I do if my insurance doesn’t cover any doctors in my area?
I lost my job last year and now work as a freelancer and have insurance from the Health Insurance Marketplace. I previously had a pretty good plan, but it was kinda pricey. I live in Tennessee.
In March, I got divorced and since that’s a QLE and I got a better subsidy, I decided to change to a provider that was slightly cheaper and actually had copays for mental health visits, unlike the pricey provider who made me pay out of pocket but counted it toward my deductible, called Ascension Personalized Care.
The thing I didn’t realize at the time is this new insurance only covers 13 psychiatrists in a 100-mile radius (Middle Tennessee). Several of those are actually doctors who work in group settings or psychiatric hospitals, but I need individual outpatient medication management. So, in reality, it’s more like 8-10 doctors.
As is the norm for mental health care in the U.S., none are accepting new patients. I need to keep my medications because they’re the only ones I’ve found that really help to any degree, as I have treatment-resistant depression.
The other problem is I can’t use out-of-network doctors because it turns out this provider is an EPO, meaning they only cover what’s in-network unless it’s a medical emergency. Out-of-network providers are the patient’s responsibility and don’t even count toward your deductible. No discount, no maximum amount, nada.
I can’t afford the $200+ per session that psychiatrists in my area charge. The whole reason I switched to this insurance was $25 copays for psychiatrists and talk therapy and I can’t get an appointment for either. A few doctors have sliding scales but despite not having money, I’ve been rejected from them.
So, basically, it’s a big waste of money. I have oral surgery this week and they won’t even cover that despite a documented need and no other doctors who can do it within 50 miles. I’ve tried submitting out-of-network requests for that and the mental health stuff and they just instantly get rejected. I tried a telehealth service that does operate in TN but got declined because I take too many mental health medications.
It seems like my only option here is to pay out of pocket, not have any of it added to my deductible, and just wait until next year and make a better choice.
Is there anything I can do here? Can I somehow change insurance again before open enrollment? Can I file a grievance or something? I don’t really know what to do but what I’ve been trying so far hasn’t been very helpful.
