Under managed care (insurance), the reimbursement rate per patient has become so low that in order for psychiatrists to make an acceptable wage, more patients must be seen thereby reducing the time that patients get to spend with their psychiatrist. Psychiatrists also must follow strict rules in order to receive reimbursement and even then, payment is not guaranteed. In order to deal with the complexities of billing, many psychiatrists employ other individuals to assist which further drives up the cost of care. Yet, in an effort to reduce costs, these other ancillary staff members are often overworked resulting in a multitude of issues.

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Patients experience the downstream effects of this by:

• short appointment times (10 mins or less!)

• poor/no communication with their psychiatrist

• scheduling issues

• medication issues

• confusing payments (sometimes even equivalent to what they would be paying without insurance!)

• long wait times with insurance companies

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I do understand that the cost of care may be high for many individuals, however I do urge you to imagine the following scenario:

 

You visit a doctor who is contracted with your insurance for a 15-minute appointment. You attempt to explain your symptoms, but the doctor prescribes a medication without much explanation. When you go to the pharmacy to pick it up, you are unable to do so due to unknown issues. You try to contact the clinic, but it is after hours, so you leave a message. The next day, you wait for a response, but receive none, so you call back and speak with the medical assistant who relays the message to the doctor. Eventually, the pharmacy processes the medication, and you pick it up. However, a few days later, you begin to experience uncomfortable side effects and try to contact the clinic during business hours, but only reach voicemail. The medical assistant calls you back the next day and advises you to stop the medication and schedule an appointment with your doctor. However, the earliest appointment available is in 3-4 weeks, and you suffer until then. When you finally see your doctor, they prescribe another medication with little explanation, which helps somewhat but doesn't completely resolve your issues. Later, you receive a letter from the clinic indicating a balance on your account. After contacting the clinic, you are transferred to the billing department, but no one answers your call, so you leave a message. Later, the billing department contacts you and explains that you need to contact your insurance. After contacting your insurance, you are placed on hold for 30 minutes and speak with someone who is unable to provide a reason and requests additional documentation that must be completed by the clinic. Over the next week, you spend hours on the phone attempting to contact both the clinic and your insurance to resolve the issue, causing added stress that leads to a decline in your mental health, resulting in the need for more time off work and less quality time with loved ones.

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Unfortunately, a situation like this is all too real and very common. I have had numerous patients describe their insurance companies and how the emotional toll far outweighs the financial "savings" that is advertised. In fact, quality psychiatric appointments can save individuals more than the cost of repeated short visits.

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I completely agree with the points that proposed by Dr. Shaily Jain in her note here.

 

So in order to provide the best possible care, I have decided not to accept insurance. I am certain that this practice model will provide an easier path forward for all my patients.

 

-Dr. Reyes 

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