Insurance woes

[Sanman]

A few interesting updates about insurance trends by psychologists. APA practice just sent out a practice update about it and NPR had a brief segment.

https://www.npr.org/2024/12/17/nx-s...al-health-practitioners-do-not-take-insurance

Looks like more and more folks refusing insurance. Seems to be what I am seeing on the listservs as well.

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[R. Matey]

Someone asked me what I thought about a therapist shortage. I was saying it was more of a 'competent therapists who also accept insurance' shortage.

 

[WisNeuro]

Someone asked me what I thought about a therapist shortage. I was saying it was more of a 'competent therapists who also accept insurance' shortage.

Pretty much. I can get patients referrals to very good doctoral services, with experts in many diagnoses. They just have to be willing to pay out of pocket. Same thing with assessment. You can wait for 4-15 months to use your insurance, or you can get in within a month if you want to pay out of pocket.

 

[medium rare]

The pandemic may have accelerated this trend but it has been a long time in the making.

I remember being in graduate school and the common lore was that there was no way to make it without taking insurance. Seeing that 1/3 of psychologists now take no insurance whatsoever demonstrates that not only is it possible, it’s common.

Taking insurance would be ideal, but current insurance practices make that impractical for an increasing number of providers, myself included. I don’t see it improving either; I have yet to meet someone who stopped taking insurance who would ever go back to accepting it.

Insurance companies have only themselves to blame for this - not that they care.

 

[PsyDr]

If Insurance creates a problem for their subscribers, then the problem is between those two parties.

Corporate America is VERY good at convincing people that the problem lies between the populace. If insurance make the business deal work for me, and I’ll become involved. Adjusted for inflation,CMS paid $168/hr for psychotherapy in 2000, and now pays $103.00/hr.

Until it’s a winning deal: Not my circus.

 

[futureapppsy2]

Pretty much. I can get patients referrals to very good doctoral services, with experts in many diagnoses. They just have to be willing to pay out of pocket. Same thing with assessment. You can wait for 4-15 months to use your insurance, or you can get in within a month if you want to pay out of pocket.

Well, willing and *able* to pay out of pocket.

 

[WisNeuro]

Well, willing and *able* to pay out of pocket.

At a certain point, if it's important enough for people, they will actually vote in their best interests. I am no longer willing to sacrifice for the poor choices others make.

 

[futureapppsy2]

At a certain point, if it's important enough for people, they will actually vote in their best interests. I am no longer willing to sacrifice for the poor choices others make.

But many of these people did vote in their best interests and were outvoted by people who didn’t.

 

[WisNeuro]

But many of these people did vote in their best interests and were outvoted by people who didn’t.

Then it is not as important enough for the majority to force change. I still do take insurance, but I have whittled it down to the easiest to interact with, and I have significantly cut back on clinical work to add in more medicolegal work. So, waitlists grow. If clinical work started to bridge that time/money gap, I'd consider increasing that amount again. But, I am not willing to keep taking paycuts to make up for poor choices and poor voting outcomes.

 

[Sanman]

Then it is not as important enough for the majority to force change. I still do take insurance, but I have whittled it down to the easiest to interact with, and I have significantly cut back on clinical work to add in more medicolegal work. So, waitlists grow. If clinical work started to bridge that time/money gap, I'd consider increasing that amount again. But, I am not willing to keep taking paycuts to make up for poor choices and poor voting outcomes.

If Insurance creates a problem for their subscribers, then the problem is between those two parties.

Corporate America is VERY good at convincing people that the problem lies between the populace. If insurance make the business deal work for me, and I’ll become involved. Adjusted for inflation,CMS paid $168/hr for psychotherapy in 2000, and now pays $103.00/hr.

Until it’s a winning deal: Not my circus.

The money is a signicant issue. However, I do think more would put up with cuts if not for the games with insurance companies. I know thd only thing I want to deal with at this point is straight medicare because you get paid on time and the rates are published.

 

[futureapppsy2]

Then it is not as important enough for the majority to force change. I still do take insurance, but I have whittled it down to the easiest to interact with, and I have significantly cut back on clinical work to add in more medicolegal work. So, waitlists grow. If clinical work started to bridge that time/money gap, I'd consider increasing that amount again. But, I am not willing to keep taking paycuts to make up for poor choices and poor voting outcomes.

I mean, don't, then--I didn't say you should. My point is simply that sometimes paying in cash just isn't a viable choice for every patient, even if they actually do truly want and need the service/assessment/treatment. The American health insurance system benefits no one but the insurers--both patients and providers get screwed mightily by them (as shown very starkly by the reaction to the UHC CEO's murder).

 

[PsyDr]

The money is a signicant issue. .....

While I feel bad for the affected: I refuse to take personal responsibility for society's ills (e.g., stagnant wages).

I think the profession goes out of bounds, when we try to intervene at the societal level. Politicians, city planners, civil engineers, attorneys, etc are the appropriate professions for societal interventions. (I also think that social psychology is a weird area of study.)

 

[smalltownpsych]

The money is a signicant issue. However, I do think more would put up with cuts if not for the games with insurance companies. I know thd only thing I want to deal with at this point is straight medicare because you get paid on time and the rates are published.

I agree that the games they play which include making more work for me and hence lots of hidden costs that I’m not really that keen on trying to micromanage. The other is how they influence or even interfere with the treatment plan.

 

[allantois]

The insurance companies follow “evidence-based guidelines”, the question is should we blame the clinicians supplying these guidelines instead of the insurance companies themselves?

 

[WisNeuro]

The insurance companies follow “evidence-based guidelines”, the question is should we blame the clinicians supplying these guidelines instead of the insurance companies themselves?

At least for assessment in my area, they haven't been unreasonable. If anything, from what I am seeing other people use for assessments and how much they bill for, they are being too reasonable. If you're doing 7 hours of testing and billing 6 units or 96133 for an uncomplicated dementia eval...you're part of the problem.

 

[R. Matey]

If you're doing 7 hours of testing and billing 6 units or 96133 for an uncomplicated dementia eval...you're part of the problem.

As are those billing 90837s for supportive therapy until the cows actually come home.

 

[Sanman]

The insurance companies follow “evidence-based guidelines”, the question is should we blame the clinicians supplying these guidelines instead of the insurance companies themselves?

Here is the issue. Those "evidence-based guidelines" vary by company, provider and are clear as mud in some cases. I have mentioned this before, I remember when the current billing codes came out and no insurance company could provide simple guidelines for which services qualified for 90834 and which 90837. Even years after the roll outs (and audits and clawbacks), I asked multiple Optum utilization review folks for their standard and never received a clear answer. The lack of clarity and transparency is the problem, not the existence of evidence-based guidelines.

Similarly, Optum has been found to pay their own doctors/healthcare providers (those clinical services owned by Optum) more than other providers of the same services.

 

[Sanman]

As are those billing 90837s for supportive therapy until the cows actually come home.

The flip side of this is that they won't actually pay more for evidence based practices. A few companies won't reimburse more for a psychologist than a midlevel. So, there is an element of you get what you pay for.

 

[R. Matey]

The flip side of this is that they won't actually pay more for evidence based practices. A few companies won't reimburse more for a psychologist than a midlevel. So, there is an element of you get what you pay for.

Lol, if insurance companies had their way, they would equip everyone's phone with a supportive chatbot and call that psychotherapy. Psychological assessment would be the PHQ-9/GAD-7/C-SRSS and the MOCA done by RN/OT every two years.

 

[AcronymAllergy]

Lol, if insurance companies had their way, they would equip everyone's phone with a supportive chatbot and call that psychotherapy. Psychological assessment would be the PHQ-9/GAD-7/C-SRSS and the MOCA done by RN/OT every two years.

For which they either would not reimburse, or would offer you $5 for your time. Obviously not inclusive of however long it takes you to complete the pre-authorization forms and subsequent reimbursement request forms; that time, you just donate out of the goodness of your heart.