Hello, I am diagnosed Bipolar and therefore take Quetiapine and Lamotrigine every day. I have been taking these medications for over 10 years, and my life is steady and fantastic. In 2017, I moved from Wisconsin to Texas.

In Wisconsin, I was receiving world class care in an alternative treatment program. I would pick up my medications from the office, pay zero at point of care, and rarely had situations where I couldn't get a refill in time before running out of meds.

In Texas, I get treatment through the offices in-network to my pathetic high deductible, low coverage insurance plan. Every few months when I run out of refills, I have to go through a time intensive process where I desperately try to find a doctor who has time for me, and the ability to authorize refills. The process requires at least multiple hours of my time.

So far I have had 3 different doctors. One doctor quit. She said she'd set me up with a replacement, but never did. My next doctor was a nurse practitioner. I found her through hours of desperate attempts to find another prescribing physician, and multiple failed calls to multiple offices. I would receive bizarre bills in the mail, months after service, charging me over $100 for a 5 minute zoom call that was required for refill authorization. My current doctor is a family care provider I found through my insurance. 

She can authorize refills, but I'm not getting any other services like psychology, even through I've experienced a lot of psychological stress in recent years with the pandemic, losing water during the Texas winter storm, and the political turmoil in the USA. I'm developing mild hoarder type behaviors. From what I understand there's an extreme shortage of psychologists here in Austin Texas. I tried calling multiple psychiatry/psychology offices but none of them said they could take me in. 

The treatment through my current doctor is totally unreliable, requiring me to plan ahead and keep appointment times, something impossible to do if I'm having a crisis, and that I never had to do in Wisconsin. I would just go to the office at my convenience and pick up my medications when I needed them. Additionally, I could see my doctors frequently, with little regard for scheduling, and with no bills at time of care. Everything seamlessly went through my insurance, a worse plan than I have now. With my current primary doctor here, I can only see her every few months, for less than 15 minutes at a time, and I receive random surprise bills for absurd amounts of money as compared to services I received.

All throughout this time I have had to pay substantial co-pays at point of care when I pick up my meds.   I currently need a refill. I have less than 3 days to pick up my pills, and I lost my physical credit cards. My phone and virtual cards didn't work recently when I tried to purchase groceries, so I had to walk away without purchase since I didn't have the ability to pay. I am very concerned that I will not have a proper method of payment to pick up my prescriptions.

I've reported my cards lost and will receive replacements, but it will take up to 10 days to receive them in the mail. This means that I could have to go one week without my medications, which is medically dangerous, especially with Lamotrigine, and after a full week off of Lamotrigine I wouldn't be able to go back on it right away. I'd have to step it up gradually with the guidance of a competent psychologist to avoid a potential lethal side effect.

Please help me with the following questions:

1) How can I reliably receive medications for the rest of my life independent of unplanned events and circumstances such as issues with insurance, catastrophes such as weather or pandemics, the inability to pay at point of care, issues with doctors and doctors offices, or other things either totally outside of my control or that depend on unreasonable levels of effort on my part?

2) How do I get care if I have a manic or depressive episode and am unable to advocate for myself, or put in the work to be accepted for treatment, or do other things that are unreasonable to ask of somebody undergoing a severe medical crisis? I am single and live alone. I need be able to do everything myself.

3) What if the USA completely collapses, and there's no way to receive any medical treatment for bipolar disorder anymore?