Sunday, February 14, 2010

Are In-Network Shrinks Better Shrinks?

Clink and I have been having a discussion about insurance participation. It's for the book. We think.

So I've made the statement that given that insurance companies reimburse according to their somewhat random (and generally reduced) rate of Usual & Customary Fees, that they require paperwork and hoops to jump through, and that there is financial incentive for seeing a lot of patients in less time, more so then in giving slow and thoughtful care, that in some communities there is a force of natural selection and that the Best docs may be the ones who won't participate in insurance networks. Is this completely true: of course not. Some really good docs (especially inpatient and consult-liason, where there is very little option) participate with insurance companies. Maybe they live in communities where it's the only feasible way, maybe they like having high-volume practices, maybe they just participate with one or two selected insurance companies to accommodate select patients (or because they've heard the company is easy to work with, or reimburses well), or maybe they feel it's the socially responsible thing to do. Oh, or maybe they worry that if they Don't, they won't get enough referrals and make it in private practice.

So, in thinking about this, I realized I know very little about docs who participate with insurance networks. None of my friends do. I participated in Blue Cross for 7 years---they never sent me referrals and they'd send me random checks for $12.44 (like what was that a portion of?) or $44 something. The UCR was different for each patient, and they were all much much less than going fees back then.

I've been assuming that to make a living accepting insurance, that the doc needs to see a high volume of patients. That's not to say that a psychiatrist might not be willing to see a portion of their practice as psychotherapy patients and take a lower hourly fee for that, and compensate by doing high volume work the rest of the day, or by offering different levels of care based on insurance. That's not to say that there aren't psychiatrists who don't participate with insurance but still have very high volume practices, but they make a lot more money then I do (or so I believe).

But it's occurred to me that I really don't know much beyond what I learned when I was in a group practice way back when. If you take health insurance, tell me how your practice works-- how many patients do you see in an hour, do you get paid from the insurance companies, do you like your work, do you feel the care you give is as good? And if you see a psychiatrist in your insurance network, please tell us how that long are the appointments, how often do you go in, how does the billing and co-pay work? And if you've seen both in- and out- of network shrinks, how were they different and what worked better for you?


Anonymous said...

My experience as a patient has been the in networks docs are harder to get appts with...they definitely seem busier. My current MD is not on my insurance, so I only see him when absolutely necessary, for med refills. If I could afford to see him frequently, it wouldn't be hard to get an appt. My psyc is on plan..and lets just say, if I were to need one of those "same day emergency appts", I can forget about it! He'll call that same day, but being able to get an extra appt is almost impossible. As a patient it would be great if more MDs were on plan because I simply cannot afford to see one out of pocket as frequently as I need to. I totally understand the reasoning behind MDs not wanting to take insurance, but there's no question it has prevented me from getting help on many occasions.

I think this is especially bad for the the MDs/psycs who see kids. After my child had a bone marrow transplant, he was pretty traumatized by the whole experience. Therapy for him would have been great. The wait for an appt for an on plan child psyc was FOREVER. The appts, shorter. The MDs who didn't take insurance had appts avail. but I couldn't afford to take him.

Whether on plan vs off plan docs being "better" experience has been the off plan docs seem better simply because I feel like there's more personalized care.

a psychiatrist who learned from veterans said...

It's a market niche. Your membership on a panel is some indicator of quality. The not so rich or even Medicaid if you take that are able to see you. For working people they often find you through their insurance internet site. The doctor may provide the float though now with Phreesia you can know the deductible. For the doctor there are significant costs in bill collecting/ scheduling but you get to see patients and they get to see you without their having as much money or time/commitment in filling out their own insurance forms as would otherwise be the case.

Anonymous said...

The question is more complicated than in or out of network. I think access is getting to be only for those with ability to pay fully out of pocket for psych MD care.
I've had the luck to have good insurance in a state (MA)with lots of mandated coverages. Have seen three psychiatrists over 20 years - first two were on my plan, one was fine, one was NOT a good match for me. Now on my 3rd psych MD - excellent credentials - she was on Blue Cross but not participating in my particular plan. So, I paid her, submitted to BCBS and got paid back almost completely, after meeting my annual out of network deductible. A few years later, she is only working parttime and not participating in insurances. Neither she nor I anticipated a problem for me, as I had been paying her directly anyway. Her fee to me did not change. BUT, since she was no longer participating with BCBS anymore, they only allowed about $70 for a fee, and then reimbursed me based on that! Her fee is $150 for a 20-25 minute meds/checkin.She wants people to come every 3 months - so, 4 visits/yr - $600/yr. BCBS will cover that as $70x4 ($280 in coverage for the year.) After I pay my $250 annual deductible, I get reimbursed $30!!!
I could ask my PCP to do the antidepressants, but he does not do benzodiazapines or hypnotics except for TINY amounts in a crisis. For my PTSD and depression, I have used these meds very carefully but to great benefit in terms of staying on a steady course. My quality of care (and of life) would be significantly less if I could not afford to pay my psych MD what she charges. But if my financial situation changes, I'll have to stop.

Anonymous said...

I saw a psychiatrist for over 5 months, once a week, who took both insured and non-insured patients.

He did 20 minute, 30 minute or 50 minute appointments for his patients. I think the 20minute ones were mostly med-checks.

The 50 minute appointments were $150 - and I was lucky that my insurance paid for $120 of that, and I could afford the $30 co-pay.
The 30 minute appointments were $90and the 20-minute ones were $60.

I saw him for psychotherapy - 50 minute appointments - because at the time, he knew that's what I needed. Since then, I see him for med-checks about every 3-4 months.

I think that many of his other patients had 20-minute med-checks (because I saw them come and go when I was in his waiting room, sometimes.)

Anonymous said...

In reference to the above comment (I forgot to add) that this psychiatrist who I saw for the 50-minute psychotherapy sessions was referred to me by a friend (who is also a social worker.)

She recommended him because she's known me for a long time, and she really trusted his judgment; she knows the reputations and quality of work of a lot of the psychiatrists in my city.I was very happy with the quality of care I received from him.

He happened to covered by my insurance, but even if he hadn't been, I might tried to find a way to see him anyway (maybe on a sliding scale fee program)- because I trusted my freind's judgment re: Who were the best psychiatrists in my city (I live in the Midwest.)

Anonymous said...

Ialso forgot to add (in reference to the above 2 comments) that - he had 2 women rinning his front office - they took care of the billing and appointment scheduling.

When I had my very first appointment with him, I came in 30 minutes early to fill out "the paperwork" - re: Which insurance I had, and basic identity and health info: Name, address, other meds I was taking, medical history questions, who my GP was, etc.

Then the woman at the front desk "processed" my insurance information (this took about 15 minutes) and then before each appointment, all I need to do is write a check for my co-pay to this doctor. That's it.

I am relieved that his office takes care of all of the insurance paperwork. I don't need the extra hassle, especially at this particular time in my life.

Anonymous said...

My psychiatrist was in-plan. I liked her and wanted to use her for both my meds/case management AND psychotherapy. She told me some interesting things. She sees nearly 750 patients. The insurance companies will not reimburse her for "therapy", only for case management. If she talks to me for more than 15-20 minutes a session they consider it therapy and won't pay her. She bills $400 for a 50 minute hour. The insurance company reimburses less than half that. My copay was $30. Due to her case load she could only take a handful of psychotherapy patients and at that time she couldn't take on another one. If she could though it would have been 100% out-of-pocket. So at least $400/week and more if I needed to see her more. If I called and was "in crisis" her staff would refer me to the emergency room but she did always return calls promptly.

I thought maybe this was just my insurance company or her practice, but in talking about this with other patients I met over the summer it is pretty much the case if you have an HMO/PPO for your insurance. This bothers me a lot because it means that the insurance companies are dictating my medical care.

I really liked this psychiatrist. It is unusual for me to open up to anyone I don't know well, but I found her easy to talk to. I would have loved to be able to do my talk therapy with her. As it turned out, once I stopped taking meds there was no reason for her see me and the insurance company wouldn't pay her at all at that point. It was very discouraging.

tracy said...

i see a (fairly young) Psychiatrist who does not take insurance and because of not having to deal with them, a receptionist, etc is able to charge only 120.00 an hour...50 min, whatever. i really like him and have been seeing him about 16 months. There is just something i don't trust about psychologists or other therapists...from past experience. (yep, i caught the capital and small "p's"...!)

i can only see him twice a month, but better than not at all.

moviedoc said...

First you we need to define (and harder yet, agree upon) what makes a good psychiatrist. Then, to do this issue justice you need to find out what the psychiatrist agreed to when she signed the insurance contract, and be mindful of the fact that this changes the allegiance: The doc works for the insurer, not just for the patient. What an insurer considers a good psychiatrist may be very different from what the patient considers good.

Anonymous said...

Non of my jobs included coverage for psychiatrists, but they all EAP plans for people having problems. I guess I would ask also about experiences with EAP providers and non EAP providers. What differences have people notices if any? Do any EAP plans include psychiatrists or only some kind of mental health worker?

itsjustme said...

I see an in-network shrink and on my insurance co's website, I can see when she submits the claims and when they pay her. After my co-pay, they reimburse her the rest of her fee within a week to 10 days of each of my appointments. Unfortuantely, I work for a very small company and we have crappy insurance that only covers 25-30 appointments a year. Once the insurance $ runs out, I'm not sure what I'll do because I can't afford to see her weekly. Last year she cut her rate drastically so that I could continue but it made me really uncomfortable. It was a really kind gesture and I wish there was some way I could repay her but I won't do it again. It's not worth it.

Anonymous said...

Do you get your oil changed at Jiffy Lube or do you go to the dealer? The dealership smells nicer, but Jiffy lube is quicker.

Sarebear said...

The first one, appt's were supposed to be about 15, 20 mins max. Occasionally they pushed long past that, but it wasn't just me - He railed at ME for TWENTY-FOUR MINUTES for my rambling wasting HIS time, and by the end of his rant I was sort of going, um, pot and kettle? inside.

Later learned that that month, he was having hard personal problems.

This was the guy, though, that when he actually listened to me, we really had this kind of brilliant synergy, when he wasn't making assumptions about where I was going with what I was saying.

I've been told by people that I think differently than most anyone they've ever met, and while I don't say that braggingly, and have oft wished to not be so different, in some ways it's been a curse, in some, a blessing, but with him, it became part of our problem, because he'd assume things, and come to conclusions, based on what stuff I'd say might mean coming from alot of people, but it might not have meant that coming from ME.

Then again, I don't pretend to be so unique that psychiatry and it's principles, as well as psychology, don't and can't apply to me, so of course there are things that can be learned from what I say no matter how "differently" I think, but still, if he'dve just listened a little more.

Generally, 15-20 min appointments. He wasn't afraid to go longer if it seemed necessary, but he was also aware of scheduled too. He wouldn't shortchange someone just because of the clock, though, even though he was primarily, from what I could tell, doing medication appointments, although he always did try to slip a bit of council and advice in as well, a bit of observation.

Just a little. And he'd call you on ANY crap he thought you were pulling, not that I EVER thought I was pulling any crap, but he did, from time to time.

He was very assertive, type A personality, definitely. Thought alot of himself, definitely.

Which surprised the HELL out of me one appointment when he told me that I was more intelligent than he was.

Sounds like I'm bragging, don't mean to sound that way. The guy, for all his brashness, and boldness, could be brilliant, at times. There were some times that I broke down and faced hard stuff about myself and said yeah, this blankety whatever, that's me . . . , or that's about me, or that's, yeah . . . or how I am, or . . . what I do, or . . . anyway.

It was over the course of, what, two years, maybe? Maybe slightly under two years, that I saw him.

I wasn't in therapy with him but there was definitely a little bit of it around the edges of the med stuff, I mean, you have to talk about how you are doing and stuff . . .

Anyway. I think he grew frustrated with some of my long appointments though, although I think towards the end of our relationship they started averaging shorter, so that problem became licked, but he had became disenfranchised with private practice, partly because of what I believe is a dubious accusation against him by a former patient, but it had led to a suspension against him for a few months early in my seeing him, where I saw a substitute, a lady, for one or two appointments, until his suspension was over. And over the course of the next 15 months, I think he spent time both deciding the course of his career, and then packing up the practice and tying it up. He switched to becoming what I think Roy does, which is a consult-liason, in a hospital?

I think it's a shame, because I think, despite my experiences with him, that his talents best lay in his private practice. He just needed a little tempering, is all.

I forget about the co-pays, I think we paid $20 at the time of the visit, generally, that was our co-pay on our insurance at the time, and I forget about the rest of the bill . . oh, I think for a time my church was taking care of paying for my mental health care, so before we paid co-pays, for a time we weren't paying anything. It was an unusual situation.

Sarebear said...

The second, more recent shrink: Appointments would last half an hour at minimum - sometimes an hour and a half, eeee. He talks alot, even right after you guys posted about that New York Times article about some of the top things psychiatrists SHOULDN't go on about, he talked about his graduate research on pregnant female rats and marijuana (on the pregnant female rats, not himself).

Lol. Sort of. I was like, omygosh, SHUT UP!!!

Then again, I suppose I was on the other end of, pot and kettle, there . . . . heh.

If he took that long with everybody, I have no idea how he made any money. Plus, he also admitted he's not a good businessman. His office was a heckuvamess, and there was sometimes dog fur in places, as well as large dog toys . . .

They have these beautiful two wierd breed Russian dogs, one certified as a therapeutic animal, and his wife is a nurse, as well as seeming to be the only office help he has, and seems to be the only one returning calls every other week maybe . . . . he has a voice mail, although the voice mail system refers to other types of mental health practitioners in the office, I never saw or heard hide nor hair of them.

I'd occasionally write a check towards the balance, but his billing people were ALWAYS behind billing the insurance, so I was always reluctant to do that cause I didn't want the money to go towards stuff that was going to get reduced by the ins. co (sorry, need to only pay what I HAVE to pay).

One time when I DID write him a several hundred dollar check towards the balance, though, when the balance had grown, he really appreciated it, and that's when he admitted not being a good business man (otherwise he woulda been all over me before that on it lol).

After I stopped seeing him it was about two months after that that the bills started coming with notices on them about how it might end up in collections, so it probably was clear to him that I'd fired him by that point, so I guess he got the idea by some point after all

I called and called the number that those little notices on the bill said, to call before x date, call this number or it'll go to collections, so I did, and i'd leave a msg to call me back. Well, no surprise, I'd never get a call back.

One of the reasons I'd fired him. Well, I'd met the condition of the notice, to call the bloody number, he couldn't send me to collections, plus I was starting to send pymnts on the bill, as well when it was clear I wasn't getting a call back I called again, with the amount I'd be sending, and asked for a call back.

A week and a half later, no call back, I called again and said, this time, I am going to assume that the payment is acceptable, since I have called the number that YOUR notice to said to call to prevent collections, and you h ave NEVER called me back, and I am sending you money.

So if he sends me to collections anyway, I'm gonna be pissed. It's not a huge bill, it's roughly the amount of that check that made him comment last time. Less so, now.

Not huge, considering the other medical bills I've got.

BUT HE NEVER CALLED ME BACK, and HE'S THE ONE SENDING ME BLOODY collection notices, or his billing agency is. So even his BILLING agency is lazy!!! ARGH.

Oh, and since I've started sending money, I haven't received any bills reflecting anything, so I'll send another amount, give it a couple weeks, and then give him a call if I don't see anything.

What do you bet that I don't get a call back . . . . I just hate sending money into the ether, with no statement reflecting the reception of said monies . . . .

Sarebear said...

Oh, also my first shrink was a D.O., or O.D., or whatever . . .not doctor of Optometry or whetever, but doctor of Osteopathy or I'm not sure that's the right word . . . . it's the other degree than an M.D. . . . holistic medicine or something versus . . . regular? not sure, they are still Dr's? Just D.O's . . . so his weird point of view is probably part of that whole thing. Not that you were asking about that. He also specialized in adolescents too, which may explain why he was the way he was too. I actually got in as a patient to him as a favor to a friend of his. He was s'posed to be one of the absolute best around, and I saw moments of that.

Sara (starting my search for a new one tomorrow, if anyone has any connections to Salt Lake County/Davis County UT psychiatrists that take UHC and are decent psychiatrists, I'd take any favors I can get to help this process be faster than 6 months to getting a new psychiatrist, I really need to stomp the anxiety stress issues, and the depression messing up my recovery as well as the above)

nonstandard mind said...

"The doc works for the insurer, not just for the patient."

This is an interesting assertion, and I wonder about the ethical implications. I practice law, and in my profession (at least in my jurisdiction) it's clear that an attorney is obligated to act in the best interest of the client--that is, the person being represented in an action--and not in the best interest of the third-party payor--that is, the insurance company. I had an interesting conversation with an insurance company attorney once wherein I threatened to report him to the state disciplinary board if he settled a lawsuit without the represented party's express permission. He was deeply unhappy with me, but he backed down, because he knew I was right.

Is this different for a medical doctor? Does concern for the interests of your insurance company employer inform your treatment of your patient? You can't serve two masters.

On the other hand, I can see where serving the best interest of your patient could require you to accede to the requirements of an insurance company, because the patient might not otherwise be able to afford treatment. Perhaps there is no clear answer here.

moviedoc said...

Nonstandard: right on both counts. There are ethical problems and no clear answers. Think how many docs are on salary and the pt. doesn't pay the doc at all. When you work for a prof liability insurer, you may not be quite the same as a contracted provider for a health insurer. If the insurer reimburses the patient directly, and the doc is not contracted that source of conflict of interest does not exist.

Anonymous said...

Medicare sucks. There are no doktors in my county who will take it so I have to drive 25 miles to see a doc at a hospital in another county. This is not good when I am too manic to drive safe. Seeing her always makes me more manic and medicare only pays for 55% of the bill so I see her has seldom as possible. Also just seeing a pdoc is a humilating experiencet that I really could do without but I have to see her to keep my SSDI.

Paperdoll said...

I am sorry and I do not mean to offend.

I don't understand how a country like the USA can have a health system that works like this. It seems to me from here, just so unjust. If this is incorrect please explain to me the benefits of your system, because I don't get it.

Any Australians out there will know the Midnight Oil song "The rich are getting richer and the poor get the picture. There must be some solution but I just don't know"

Yes, I have said before, I am a dr. specialist and a patient doing really well on prozac and wellbutrin. My pdoc has changed my life. Here, if we are referred to a specialist by our GP, most ( but not all of the fee) is covered by the government from our (my) taxes (and I pay way more than most) and I don't begrudge a soul the right to first rate medical care.

Network or non-network, the system doesn't seem like a level playing field.

paperdoll said...

I always see the typos too late.

line three, last word should be "correct"

tracy said...

@moviedoc That is why my Psychiatrist does not take insurance-so he is working for the patient, not the insurance company.
As well, he can charge much less than if he took insurance.

nonstandard mind said...

Perhaps in a sense, out-of-network psychiatrists are "better" doctors, in that they are able to treat their patients unfettered by the artificial constraints imposed by the bean-counters of the insurance industry. I think that a doctor that's able to exercise his or her medical expertise without regard to external pressures must be "better" from the perspective of the patient, anyway. It would be interesting to know whether out-of-network doctors have better treatment outcomes, though I don't know how you'd study that issue.

Anonymous said...

For what it's worth, It really wouold matter a lot to me if any psychiatrist I saw did not have office personnel (or someone) helping to process the insurance paperwork for me.

In fact, I hate the idea so much, that would automatically cancel that psychiatrist off my list of potential care providers, regardless of their perceived quality as a doctor.

Because I suffer from severe depression (which is currently being successfully treated), and I just can't see how any compassionate psychiatrist could honestly expect their patients to have to dealwith their insurance company one-on-one, just to get decent care. What a nightmare that would be!

Anonymous said...

Out-of-network providers who don't take insurance: I think one sees this way more often in psychiatry than in any other specialty. I go to a pdoc who doesn't take insurance and I pay cash. My husband, who pays an arm and a leg for the health insurance via his employer then harangues me constantly. "Why am I paying for coverage, if you don't use it?" But he has no idea how important it is to find a provider that you actually like and want to stick with. And my insurance company does reimburse some pittance after I go through some complicated hoops.

One thing I have never understood is the wisdom of a self-pay office. It's fine for routine medication check appts., but what if one were to become a lot sicker and one lost one's job? Would the patient have to come in more often for treatment? And how would she be able to pay for being sicker? If you relapse, do you price yourself out?

My PCP got me into this boat. When I told him I needed to find a new psychiatrist due to the rules of the clinic I was attending (can't pick your own psychotherapist--has to be one of the clinic's two), he handed me a list of mostly inappropraite clinics and then wrote in the name of my current "no insurance, please" pdoc. He warned me that the pdoc did not take insurance, but assured me it would be okay. I later found out the pdoc is married to one of the PCP's colleagues. Take about a conflict of interest!

Child Psych said...

This is an interesting topic--thanks for asking. I am the other kind of psych--a psychologist. Because med checks are not possible for me, the only way I could increase the number of patients I see is to increase the number of hours I work. I don't because having a balanced life is more important to me than a higher income. I have tried it both ways--on insurance panels and fee-for-service. For various reasons, I currently accept a few insurances even though I HATE dealing with them.

I would like to take issue with the comments that those who take insurance work for the insurance company and not for the patient. In actual fact, by signing a contract, the provider agrees only to accept less money for their services, charge patients their deductibles and co-pays, and do the insurance billing for the patient--all of which directly benefits patients, not the provider. In actual fact, insurance companies don't dictate treatment, they only dictate payment for treatment. Only ethically challenged mental health professionals would put personal, financial considerations ahead of what is best for the patient by tailoring their treatment in order to get paid.

I am concerned by the comments that some patients see fee-for-service psychiatrists/therapists less often than they need to because of the cost. I have had parents (I see kids) start out willing to pay out-of-pocket because of my reputation who, once the crisis has passed, start finding reasons to bring their child less often due to the expense. I personally find it difficult to insist that I see their child weekly when I know they can't afford it and they have rejected my offer to decrease their fee due to pride.

So, let me end with a question of my own. Given that the majority of patients cannot afford to pay for all the treatment they need out-of-pocket, isn't the quality of care affected by patients decreasing their visits based on finances rather than their treatment needs?

moviedoc said...

Child Psych: I have seen insurance contracts that are 6-10 pages long. If you sign one of those, you agree to a whole lot more than a reduced fee, but it does depend on the carrier. Then there is managed care.

As for money vs. quality: There is reality. Having read that 40,000 people died in one year because they could not get medical care, the notion that someone might have to make do with psychotherapy only twice a month pales by comparison.

Sarebear said...

Child Psych: Hi! I like psychologists, I do my therapy with one. I know that periodically my ins. co. has me fill out a form, sometimes they send it to him to have me fill out, sometimes they send it straight to me, but they like to see improvement, or sometimes see that I still need therapy, or I don't know what, it's kind of a . . contradiction? . . because if it looks like I'm never improving, why would they want to keep authorizing it, & paying, but then, when I first started therapy, that was before I had this arthritis crap start, & then further physical medical diagnoses, & this year seems like therapy is going to be taken over dealing with the stress of THAT.

I've had to down the frequency of my appts as well due to med expenses - the tax return is going first to the first bill of the year, which I just found out this week what it was reduced to by the ins co, for the home health/pt visits - $675.

Then, the rest of the tax return is pretty much going to let's see mail order three months of topirimate and omeprazole (never would have mail ordered, but when it was made clear that three months of my mood stabilizer was only $15-$20 more for the WHOLE 90 DAYS SUPPLY than ONE MONTH at the local pharmacy, that was a huge wake up. I had never known how much omeprazole would cost, having only gotten it before the year's end after ded. was met, but it seemed as tho the whole 3 month's supply would cost less than 1 month's worth at the local pharmacy, & while I hate to do that to my Mom & Pop place, the savings are TOO MUCH. I even asked questions about a whole host of temperature/medication/shipping issues, considering the extremes in winter and summer here. I haven't started the topirimate yet, so it wouldn't have played a part in my recent 200mg issues, THAT much I know.

They even let me pay for a third of it a month, the 2 meds together are HALF what the mood stabilizer used to cost me per month. Before the $5k deductible.

Third, so far the ins. has processed just under $900 of physical therapy claims, & that's the amount AFTER they've reduced them by a huge amount (this includes the first 10 visits that were double visits where husband also had physical therapy, for his shoulder). This is caught up through the early week of the month

Let's see, Oh & I paid my psychologist for the first 2 months of therapy this year, seeing him twice a month. Couple weeks in a row end of Jan, when I felt more up to it, & spaced more out in Feb, the second of which I haven't seen him for yet. This goes against the protocol our Ins. Co. has said, which is don't pay anything until they've billed us, we've processed, & then you get EOB, & their bill reflects what we've done, but I've seen him for so long, that this is the first I've done this, & I said look, I know this isn't the way I've done this before, & it's against the way my ins. says to do (so he knows to submit the usual way, & besides, he pretty much indicated this'll go towards the balance, it really won't show up as having been towards those particular visits anyway, so it all works out & won't look funny to the ins. co anyway), but I've seen him so long, & I wanted him to get some before the tax return was GONE, cause it's a gonna be pretty durn quick.

I'm hoping I don't have to go down to ONE visit a month to my psychologist, because if anyone reads my recent novels of posts or comments lately, you'll know that my stress is out of control, I've lost 13 pounds in 13 days, before that still a weight loss rate that is too high more than a pound a week, sometimes 1.5 pounds in half a week


Anonymous said...

I have a problem with the whole no insurance concept. While I realize one may believe that if s/he does not accept insurance s/he will be treating the client rather than the insurance company, the number of people who could afford the care would be significantly altered and affected.

For example, I already experience discrimination when trying to find care (thankfully I have had the same practitioners long term at this point)because I've been diagnosed with Borderline Personality Disorder. But I'm digressing. I am a full time student and live off of SSD/I. I'm lucky that I still have private insurance through my parents though. However, if I did not have this insurance, or was attempting to visit a practitioner who did not accept the insurance, it would be impossible. Literally impossible.

To me, it seems like a practitioner who refuses to take insurance is practicing elitism. I'm glad that there are enough rich people for them to treat, but it's not the 'average' people. There is no way a 'normal' person would be about to afford $400 a week. Or $165 a week which is what my therapist charges. Without the insurance, it would cost me about $800 a month. That's more than I make!!!! Not to mention medication co-payments.

Dinah said...

I agree that not taking insurance does turn into a form of elitism at least in theory. The problem with this formulation of the issue is that it gives the doctor a funny either/or: You're either an elitist practitioner, OR you're willing to deal with a huge administrative burden and lower fees which may well never get paid. There's a problem with the system: more doctors would participate if getting paid was easy and reasonable. And I do think it's more about the administrative burden then haggling about slightly lower fees.

There's some element of choice for some people. I treat people who pay for care who clearly would be seen as 'not able to afford it'. Nearly all of these people have had prior treatment experiences which were unhelpful. And they only come weekly while they are ill-- they stretch appointments out after that, often to once a month or once every 6 weeks, and sometimes for half appointments, and most get reimbursed some from insurance.

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