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Psychiatry and Psychotherapy and Insurance

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

On March 6, 2011 The New York Times ran a disturbing article about the state of psychiatry today versus twenty and more years ago. The article appeared on the front page of the Times entitled, “Talk Doesn’t Pay, So Psychiatry Turns to Drug Therapy.” This issue is similar to one that was recently discussed in a blog posted in May 2010 that can be found at this URL:

http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=36766&cn=91    

The problem is that psychiatrists are not able to earn enough money by engaging in talk therapy as they did years ago. Their sessions with patients lasted 50 minutes and they often met at least two times per week. However, insurance companies refuse to reimburse doctors for this type of service because it takes too long and is too costly to reimburse. As a result, modern psychiatrists are forced to meet with patients fifteen minutes once every month to two or three months. Sessions are no more than fifteen minutes and case loads are so heavy that the old therapeutic intimacy between doctor and patient is no longer available.

You might think that this is of no importance to patients who seem to recover with medication alone. However, studies show that talk therapy works better for depression than medication. As a result, psychiatrists refer their medication patients to psychologists and clinical social workers who provide talk therapy at a much lower cost than psychiatrists. These clinicians provide therapy deemed just as good as that by psychiatrists but it splits the way services because patients are forced to see two clinicians instead of one.

Observations:

Insurance companies continue to dictate how therapy is conducted even for psychologists and social workers. For instance, they limit the number of sessions for which they reimburse, ranging from ten to twenty per year for no more than two years in a row. Psychologists and social workers collect a co pay of twenty five dollars and the insurance will pay another 50 dollars to for psychologist, but, for social workers no more than 25. In many cases, these clinicians are members of insurance panels from which they receive referrals. They have no choice but to accept the limitations provided by these companies.

At this low rate of payment, clinicians are forced to submit endless numbers reports in order for treatment to continue. This causes voluminour amounts of work that further cuts into available time that could be spent seeing patients.

The consequence of all this is that many clinicians, among them, psychiatrists, psychologists and social workers, resign from insurance panels and refuse to accept insurance reimbursements. Patients must pay the full fee up front and collect what they can from their coverage.
There are many practitioners who are willing to see fewer patients but at much higher fees.

Other areas of medicine:

This trend is happening among other medical practices. Most medical doctors work as part of group practices rather than private practice. Many of these medical groups accept only certain insurance companies and many of them flatly refuse Medicaid its reimbursement schedule is so very low. In addition, many of these groups restrict themselves to only certain hospitals and not others.

In a private conversation, a physician told me that doctors are no longer working for hospitals because the pay is so low. As a result, the hospitals are staffed with younger and less experienced physicians.

What To Do:

1. Each insurance company has a list of all the practitioners on their panels. Patients choose among them in order to make certain that their fees are covered. However, when calling an MD, Psychologist or Social Worker, from that list, it is important to ask if they continue to accept that insurance. Things are changing fast and many professionals are leaving panels before new lists are made.

2. For those of you who are inclined towards political action, calls and letters to your representative and senators in your state as well as those in Washington DC can help if you gather enough people to write similar letters.

None of this means that Americans will be left without professional medical help. That will always be available but in a way that may be less satisfactory to all involved.

What are your thoughts, opinions and experiences about this dilemma?

Your responses are strongly encouraged.

Allan N. Schwartz, PhD

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