What do you do when your child is benefiting from very expensive therapy you struggle to afford? Sacrifice your own insurance

When the session was over, our new therapist tried to scan her Venmo code, but there was a glitch with my bank account attached to our Venmo. Even though I knew, because I’d checked before we came, that the $305 this session cost was in our account, I started to sweat. She is only doing her job, I told myself, having been a person who charges hourly rates and had to collect them. Then the payment, for whatever reason, finally was able to go through. She’s worth every penny, I reminded myself, as my daughter and I gathered up our shoes and coats in the light-filled waiting room, complete with a wooden dollhouse.

Two years ago, through a program that our daughter’s pre-K teacher recommended, we agreed to be a part of a city-wide study that granted our daughter a course of tests over a period of months at no cost. (This kind of testing would usually cost about $2,500). We got a diagnosis of ADHD for our now seven-year-old. None of the other psychiatrists we needed to continue helping our daughter takes insurance, said the doctor who gave us the diagnosis. The doctor she recommended most strongly, and, how could I help myself, the one I immediately felt we needed to see, cost $395 an hour.

We can’t afford it, said my husband.

We don’t have a choice, I said.

We sat with the doctor for an hour and in the end he offered to write our daughter a prescription but with no follow-up or regular therapy. I said that we weren’t ready. She was only five then. He offered to talk again to us on the phone, still $395 an hour, but we only ended up speaking for 20 minutes that second time. We decided to hold off on the meds.

What do we do, though? I asked my husband when she was on the floor throwing a tantrum, when we were out in public and we knew her lack of bodily control was not her fault, when I was reading five different books on the topic only to be left more confused by the disparate opinions I read.

We just keep helping her, he said.

When we got home from the new therapist a few weeks ago, our daughter kept asking to go back. It will work, she told me, right before bedtime. Her sister asked if she could go also. It’s for kids who are older, I told her. Is it because she doesn’t listen? asked our younger daughter, then proceeded to not listen to anything I said the rest of the night.

It’s expensive, I said.

I have money saved, our seven-year-old said.

In the waiting room of our new therapist are shelves of expensive toys that I recognize from the toy store we only ever walked by in our old neighborhood in Brooklyn. There is a large mirror and lots of tools allowing our daughter to use her body in ways that helped her to focus in the room we were counseled in. Intuitively, instinctually, it feels like a space where my daughter will flourish. Is it just because of how beautiful it is? Is it because capitalism has taught me to believe that beautiful spaces are better than spaces that are not beautiful? Is it because I want to be the sort of parent who can give her child beautiful things?

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The therapist is careful and thoughtful. On the wall, in the waiting room, are her degrees, all from fancy places. She is worth the money, is what I’m trying to say. Of all the things in the world for which a person might pay $305 there are few things I was more willing to pay for than this.

When I was a private SAT tutor, an hour with me cost more than an hour with this therapist. But the SAT, then, to me, felt like a higher-order concern. Whereas this help for our seven-year-old – who feels less overwhelmed now by being asked to pay attention in class or to not come into our room at night because her brain was whirring and telling me she was worried that no one understood that she didn’t listen when people told her things – feels entirely necessary.

The friend who recommended this therapist said her family had 70% covered by their insurance through her husband’s job, which I knew was better than ours. Our insurance – which is through Child Health Plus, a nationwide program controlled by the states that subsidizes healthcare for children who don’t qualify for Medicaid but whose families can’t afford or don’t have access to private insurance – can pay for care on a sliding scale. It’s great in some ways. It’s great if you don’t leave the state, for instance; elsewhere, almost none of the care you seek is covered. It’s great, it turns out, as long as you don’t seek mental healthcare, which is, according to the website and three different conversations that I had with representatives, not covered at all.

This story doesn’t end with total despair and it also doesn’t end in victory. I’m still investigating other insurance options for our children. The therapist has an associate she’s offered to transfer our daughter to who charges less. This is, for now, a story about the way the systems under which we live force us to make choices that might at first feel impossible, about trading and compromising amid what used to feel like necessities.

In the meantime, what we’re doing is no longer paying for the private health insurance my husband and I used to be covered by. We were paying $1,430 a month for healthcare – well over 10% of our combined yearly income – with a $7,500 deductible. We’ve only used it a handful of times. We’ve often had to cut this cost before. The choice in this way feels almost uncomplicated: our baby’s struggling and we believe this therapist can help her. Whatever happens to my husband and I in the meantime, nothing feels as dire as addressing that.

