A month or two ago, I was trying to set up a pediatric dentist visit for my son. Not a medical emergency, but a matter of some urgency. I spent about three hours on a total of a dozen phone calls or so. Some to the insurer, and some to various dentist offices in the region to inquire about scheduling and logistics. I learned that I needed to switch my son's primary office before he would be eligible to receive care. This could only be done once per month. Fortunately, by luck, this would take effect at the close of business on that very day. Next I needed to find a covered provider. Of course, the insurer could not tell me which ones would have openings at short notice, so I had to call several. Then I learned that in order for a pediatric visit to be covered, it needed a referral from a general dentist. The pediatric office helped me find a dentist who could fill out this paperwork, which felt lucky. I verified that my policy worked with this dentist office. Several hours on the phone, but I had a sense of accomplishment for sorting it all out.

The day of the appointment came. The visit went smoothly. Then I found out that it wouldn't be covered because the insurance will not cover pediatric dentistry above the age of 6, but my son is 7.

I think I'm going to opt out of dental insurance altogether in the next enrollment. All the individual people seemed to be doing their best to help me, but the end result is a system that is impossible for me to use.

I also understand the hesitancy to pay for two months at a “retreat-like inpatient psychiatric facility.”

In publicly funded system, it’s likely facilities like this would not exist or would be strictly private pay.

I’m not aware of any country that makes such a thing available on short notice like this.

I also understand the frustration, as often times facilities like this are all that exist in terms of medium-term care. And often times some of their services are at least formally in-network.

The understanding is you pay for it by selling your house.

We’ve been tempted to do this (sell our house), but been advised against it - but the reasoning in our case is patient specific.

I wish insurance was clearer about what covered and what isn’t. I wish we had more mainstream (not retreat-like) medium term care places.

Maybe I’m misreading the phrase retreat-like.

But id this isn’t something a public system would pay for, it seems inappropriate to blame a private system to not pay for it, unless it’s clearly in the wording.

Regardless, mental health care in America stinks, and you can always argue over the details.

Considering this person has a high-paying job and it seems like a short-term intervention would have created a long-term positive outcome, it’s not clear to me why they didn’t simply insist on the care without insurance coverage.

My contingency plans for these situations are to pay out of pocket and figure out reimbursement later. In practice, paying out of pocket is just a promise to pay out of pocket. Often one isn’t charged until afterwards and I experienced sufficient mechanisms to delay payment until the whole thing had been sorted out.

Permanent conditions (like, say, brain death) are a different story. But in my case, the bill I was ostensibly facing was hundreds of thousands of dollars and I proceeded with it on the grounds that rapid intervention would yield results and I can figure out the payment structure later. If I were facing the worst case scenarios of a family medical bill bankruptcy or family member loss I think that usually I’d prefer the former. It’s hard to make a decision in the moment, but if the healthcare provider determines that more care is required and the insurance provider that it is not, I am more likely to follow the former though not without bound.

Specifically regarding mental related items are treated as lesser than physical issues. I have Kaiser who has actively been punished by the US Department of Labor [1](2026) [2](2021) for delays in behavioral health care and pushing for out of network therapist. They tried to push these therapist on me twice, both through RULA and it was really a terrible experience. The therapist literally ended my meeting 10 minutes into our discussion when I told him I hadn't finished reading the book he recommended. I am now with an in-house kaiser therapist that is working well. I worry about the psychiatric side of the house as well, they set me up to only meet with my psychiatrist once every three months. That doesn't feel frequent enough to get my medication tuned right.

I don't see this getting better in the future with the current leadership in the US advocating for a "return control to the patients" by reducing SSRI prescriptions. [3]

My only advice for people out there is to take their mental health seriously, if you are having suicidal thoughts talk to your doctor. It may end up being a difficult journey but its better than being alone.

1. https://www.dol.gov/newsroom/releases/ebsa/ebsa20260210

2. https://calmatters.org/health/2023/10/kaiser-permanente-cali...

3. https://www.pharmacytimes.com/view/announcing-new-initiative...

We are graduate students and get a pretty good health insurance through our university's BCBS plan. She is financially independent from her parents, but she is additionally involuntarily insured on her father's EmblemHealth plan with no right to remove herself (her father could do this for her, but has refused to).

Last year she had some medical bills, and neither insurance company is willing to pay: the issue is that both plans have a clause that makes them secondary to any other insurance (this is apparently very common for student plans, and is also also somewhat common for additional family members on regular plans). For over a year now we have been sending certified mail to both insurers' coordination-of-benefits offices, but neither will acknowledge being the primary insurer and EmblemHealth has been ignoring us altogether for the last ~5 months.

The generally recommended strategy in this situation is apparently to involve regulators. However, regulation is state-by-state and and our university is in Massachusetts while her father lives in New York. Massachusetts' Division of Insurance found that the Massachusetts insurer (BCBS) was correct that the New York insurer (EmblemHealth) should be primary, but they have no jurisdiction to force the New York insurer to accept this finding.

The New York regulators were even more useless. New York's Department of Financial Services---the only state regulator for health insurance---responded that they had no jurisdiction to regulate the plan since it was self-funded (meaning that it is not technically insurance for regulatory purposes). The only remaining regulator was the US Department of Labor, but they eventually got back to us saying that they had no jurisdiction either: the problem is that my partner's father is a municipal employee of New York City, and for some complicated constitutional/political reasons the DoL isn't able to enforce labor laws on state/local governments.

I basically don't know what to do now. We have been on a waitlist for a legal clinic for about 4 months with no end in sight, and in the meantime regularly get mail from medical debt collectors. This is despite having insurance and making considerable effort to do everything "right." Clearly something here is extremely broken.

More than once I was on the hook for a $15k set of injections that I had to run on a credit card. At this point, I'm maxed out, paying out of pocket for what I can and it sucks... I'm hoping to convert to a City employee (temp) vs contractor which at least gets decent medical, but my own experience has me doubtful even then. I've worked my whole adult life, didn't even take vacation time through my 20's and 30's... and never planned to retire... I don't want to, but I'm facing a reality that may not give me a choice in the long run.

I don't think shifting to public healthcare is the answer in the US... but would like something similar to fiduciary safeguards around medicine and insurance.

Haven't all other (non-universal) health coverage possibilities been exhausted ?

In this particular instance, the insurance company saved money to give to shareholders and their C-suite by not treating the patient further. They lose no money by allowing him to die.

This is all by design.

You see, dear, your critical error was in believing that psychiatry is “medicine”, and that mental health treatment is “health care”.

Oh for sure, they present you “doctors” and “nurses” with the same credentials, wearing white lab coats, ties, scrubs, and even stethoscopes. They can prescribe “drugs” and run “hospitals”.

From the outside, they are indistinguishable from physicians who treat the physical body, but it is all a satiric cosplay. It is done this way for reasons, chiefly not to scare people too much.

Mental health should be considered more of the “Pre-Crime Division” or Department of Corrections For Stuff That’s Not Your Fault.

Don’t ever believe they’re in “Health Care”. This is a fatal category error.