Obamacare & Accepting Insurance

[neutralpalatte]

I looked at the other 7 or so Obamacare threads, but none of them I read touched on this...

For those of you who are currently in private practice (LMFT, LCSW, LPC, PsyD, etc) in that state of California, how has the Obamacare movement affected your private practice payment system?

I know that now insurance companies (at least in California), regardless of the client's income level, require the client to pay the therapist/psychologist/doctor 100% of the cost upfront, and then the client is given a "superbill" at the end of the month that they can submit to their insurance for reimbursement.

Many clients obviously cannot afford to do this... Paying ~$600+ ($150 x once a week for 4 weeks) or so upfront... Then waiting to the end of the month for the superbill, then weeks for the reimbursement checks from insurance companies...

Has the new Obamacare insurance regulations caused you to lose clients? Is your practice still the same? How has this affected you so far?

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[Therapist4Chnge]

The problem has much more to do w ppl paying their first month premium, racking up a bunch of bills, and then dropping their insurance and the clinician gets stuck w the bill bc the insurance company doesn't have to pay out.

 

[neutralpalatte]

The problem has much more to do w ppl paying their first month premium, racking up a bunch of bills, and then dropping their insurance and the clinician gets stuck w the bill bc the insurance company doesn't have to pay out.

I'm aware. What are people's experiences with this so far? Is this now a common thing?

 

[Therapist4Chnge]

It stinks. Between that and the high deductive plans ($3000+ before the insurance pays anything) the clinician is often writing off thousands of dollars per pt (if doing assessments) and hundreds (therapy/other).

 

[erg923]

My work outside the VA is not direct clinical service, and even if it was, I wouldn't take any insurance. Period. I do not think its financially viable set up for PP in the future...and it barely is now.

Our ethical code instructs/encourages us to provide services pro bono, which I support wholly and I accomplish by (voluntarily) donating my time and talent at local skilled nursing facilities/homes. This seems to be a much better use of this ethical aspiration than providing consistently under-paid services, from whatever 3rd party entity.

 

[OneNeuroDoctor]

With all of the new individuals now having insurance the agency where I work at now has many more clients. Most of these clients have long term mental health disorders but have fallen through the cracks or been in the gray areas prior to ACA.

We accept all insurance, Medicaid, and Medicare and the reimbursement rates are going to increase in January based on The Affordable Healthcare Act.

With the private option many have BCBS and because they have no income and do not qualify for Medicaid/Medicare they do not have any copayment or deductibles for outpatient mental health services.

Basically it is equivalent to Medicaid coverage via private insurance plans.

Psychologist in private practice frequently will not accept Medicaid or Medicare or only will accept 10-15% clients with Medicaid/Medicare. With the reimbursement rates increasing in January, mental health providers will have greater reimbursement.

 

[WisNeuro]

Psychologist in private practice frequently will not accept Medicaid or Medicare or only will accept 10-15% clients with Medicaid/Medicare. With the reimbursement rates increasing in January, mental health providers will have greater reimbursement.

Has there been a new update, last I heard many services were actually getting a decrease in reimbursment?

http://www.apapracticecentral.org/update/2014/07-24/medicare-fee-schedule.aspx
"Medicare’s reimbursement pool for psychological services is anticipated to drop on average by about 1 percent in 2015 due to adjustments in practice expense."

 

[OneNeuroDoctor]

In the State where I work, psychologist will receive an increase for Medicaid as the private practice rate will be at the same rate as the CMHC rate and CMHC rate is being increased.

I believe where I work we are considered a "Medical Care Home" for Comprehensive Mental Health Care.

 

[WisNeuro]

Is this codified somewhere? Or is this just speculation? Also, if that is the case, it seems that some providers may see a slight increase in remimbursement, but many will actually see a decrease.

 

[OneNeuroDoctor]

This is what my supervisor has indicated where I live.

 

[WisNeuro]

Well, I hope that is the case, but I would hold off reporting it as fact until I saw it in writing. Often what we hear is going to happen doesn't always coincide with how things actually work out. Especially when CMS is involved.

 

[Therapist4Chnge]

Unless it is a significant increase I don't see it helping much. Some providers who were going to leave may stick around a bit longer, but I'm not sure providers who left the system will be chomping at the bit to get back in. With the flood of newly covered individuals and little to no change of providers, I'm not sure how these people are going to be seen.

 

[OneNeuroDoctor]

From my brief review on the internet, it appears that Medicare reimbursement may go down but Medicaid reimbursement will go up via the private option and Medicaid Payment Initiative here in Arkansas over a five year process until 2018. I in no way have said I am an expert, but just my administrators seem to be saying we will get a higher Medicaid reimbursement rate in 2015. Here is a link to the Arkansas Initiative:




http://www.achi.net/Pages/OurWork/Project.aspx?ID=47

 

[smalltownpsych]

I don't practice in California and each state is operating differently under this federal law. At the hospital where I work, there is a consensus amongst providers and staff that Obamacare has not really helped anyone get more access to care. I am including business office staff who know the numbers in this. For myself, in my outpatient practice, it has not helped any of my patients. Many still cannot afford insurance and if they are poor enough are using the state programs that were already in effect. The people who have insurance through their employer, nothing has changed for them except increase in costs. Final note, my former employer dropped health insurance because of ACA and we could all sign up for the exchange. Ergo, former employer.

 

[neutralpalatte]

Is this codified somewhere? Or is this just speculation? Also, if that is the case, it seems that some providers may see a slight increase in remimbursement, but many will actually see a decrease.

I have been hearing both sides. That's why I'm asking. I'm curious to see what will end up happening, for the better or not.

 

[WisNeuro]

By and large, most likely a decrease, unless the state does something different, which is unlikely given the economic climate of most states. Hence, my advice not to look at PP as the panacea of the field's woes.

 

[neutralpalatte]

By and large, most likely a decrease, unless the state does something different, which is unlikely given the economic climate of most states. Hence, my advice not to look at PP as the panacea of the field's woes.

I just ONLY want to do private practice, so that's why I was asking. But its more of a time-will-tell thing because the new insurance regulations due to the Obamacare act still has a lot of tweaking to go.

 

[WisNeuro]

And that's fine, I have no problem with that. I do, however, have a problem with telling students that APA match doesn't matter because everyone can be successful and happy in PP. PP will only become harder and harder to manage in this climate, and cutting off some of the largest potential employers is not good advice.

 

[smalltownpsych]

I just ONLY want to do private practice, so that's why I was asking. But its more of a time-will-tell thing because the new insurance regulations due to the Obamacare act still has a lot of tweaking to go.

Yep. It definitely will get more tweaking as the large insurers squeeze more money from the healthcare system. In my opinion, the only tangible result of ACA is for the insurance companies to make record profits. I have already seen patients have to pay more (for insurance, not healthcare) and am just waiting for them to start squeezing my reimbursement which is the next step in the ACA from what I have heard. Performance-based compensation is what they want to promote it as. It sounds good, but in case people haven't noticed yet...they lie!

 

[Therapist4Chnge]

People should be very wary when they start hearing phrases like: "performance-based compensation", "cost/waste cutting", "leaner", etc. Those are all code words for finding ways to cut reimbursements and squeeze providers.

 

[CaliMac]

Would that things could be run like a generous small business; hourly/salary as a base, performance-based/piece-work as a motivator.

 

[smalltownpsych]

Would that things could be run like a generous small business; hourly/salary as a base, performance-based/piece-work as a motivator.

That is actually the way that my compensation is determined. I get a percentage of the gross billing. If I do a good job, my patients keep coming back and then they refer their friends and my hours are filled with billable activities. Most patients expect results and are not going to pay for long-term moonbeam therapy. In a big city, you might find enough gullible people to support that model, but I have seen lots of part-time private practice types that don't make much money seeing the few individuals that are willing to pay for not getting any better. I also worked for a few years in a treatment facility that was completely for-profit, cash-only. The level of care that we were able to provide for the kids there was phenomenal. I have also worked in community mental health with therapists that I wouldn't refer my neurotic cat to. In short, it is often true that you get what you pay for.

 

[CaliMac]

That is actually the way that my compensation is determined. I get a percentage of the gross billing. If I do a good job, my patients keep coming back and then they refer their friends and my hours are filled with billable activities. Most patients expect results and are not going to pay for long-term moonbeam therapy... I also worked for a few years in a treatment facility that was completely for-profit, cash-only. The level of care that we were able to provide for the kids there was phenomenal. I have also worked in community mental health with therapists that I wouldn't refer my neurotic cat to. In short, it is often true that you get what you pay for.

My education-planning focus reads that as "go for the VA practicum and split internship between VA and PP."
Probably also "don't aspire to the level of care at (at least some) CMHCs."

When I was paid, in an unrelated field, as described above, I worked my heiny off, was much-appreciated by clientele and had packed-to-capacity sessions.

 

[Therapist4Chnge]

Most patients expect results and are not going to pay for long-term moonbeam therapy.

I knew "moonbeam therapy" would catch on!

 

[smalltownpsych]

I knew "moonbeam therapy" would catch on!

http://www.newscientist.com/blog/space/2007/12/can-moonbeams-cure-what-ails-you.html
It's gone viral.

 

[Therapist4Chnge]

I thought this was a discussion worth bumping.

How are people doing w. Obamacare now?

 

[smalltownpsych]

Our hospital actually received some money through Obamacare so admin is not 100% against it now. Only about 95%.
I don't have to do the extra paperwork related to the meaningful use stuff yet and am dreading that.