ProPublica Article on Mental Health

[Sanman]

ProPublica article on why so many mental health professionals are leaving insurance networks. Thought I would share it here.

Why I Left the Network

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[WisNeuro]

Just left a couple panels in the past year, and the cash pay portion of my clinical base has increased accordingly. There were a couple of panels that just required so much time on the phone, navigating stupid prior auth procedures, and an inability to speak to a human being, that it was no longer worth it.

 

[R. Matey]

I think it's a bit of two-edged sword. Low-quality therapists are part of the equation (i.e., insurers paying for IFS, infinite supportive therapy, SE, and other sham treatments) that have made insurers rightly wary of psychological services. Notice that one person was testing for ADHD who did eventually get paid (insurers around here would've flatly denied that claim). That said, the process of reimbursement is way too opaque and bureaucratic to make it worth it for many providers. The low reimbursements only add insult to injury especially when therapists can't bill them for administrative costs.

I'm not sure what the answer is. It seems the social contract should be that if a psychologist brings their best, the company responds in kind with timely payments that reflect one's expertise and the cost of living. There was a major insurer around here that was losing tons of money on mental health that did not have a UM process in place. When they instituted one, tons of therapists (especially mids) freaked out on the local listservs. A friend of mine working at UM at said company told me the process is mostly meant to screen out so-called 'bad therapy'. which they defined as not adhering to evidence-based practice. How that's defined and enforced, I have no idea.

 

[Sanman]

I think it's a bit of two-edged sword. Low-quality therapists are part of the equation (i.e., insurers paying for IFS, infinite supportive therapy, SE, and other sham treatments) that have made insurers rightly wary of psychological services. Notice that one person was testing for ADHD who did eventually get paid (insurers around here would've flatly denied that claim). That said, the process of reimbursement is way too opaque and bureaucratic to make it worth it for many providers. The low reimbursements only add insult to injury especially when therapists can't bill them for administrative costs.

I'm not sure what the answer is. It seems the social contract should be that if a psychologist brings their best, the company responds in kind with timely payments that reflect one's expertise and the cost of living. There was a major insurer around here that was losing tons of money on mental health that did not have a UM process in place. When they instituted one, tons of therapists (especially mids) freaked out on the local listservs. A friend of mine working at UM at said company told me the process is mostly meant to screen out so-called 'bad therapy'. which they defined as not adhering to evidence-based practice. How that's defined and enforced, I have no idea.

The bolded in a somewhere between well wishing and a flat out lie. Your friend may be buying the insurance company b.s., but I know folks high up in the health insurance industry. The goal is to cut costs and create headaches, though they will never admit it outside a meeting that is not VPs and up. If that was true, every insurer would publish clear guidelines and post them on their website. They don't and even the UM people cannot explain the guidance clearly. Each insurer also has its own standards for EBP and medical necessity. How is that possible? Even after United Healthcare and other insurers have lost the fight and paid fines in multiple states. The answer is because the policy still makes money even after the fines. At the end of the day, the goal of a publicly traded company is to show quarterly profits, not provide generous healthcare subsidies.

 

[R. Matey]

The bolded in a somewhere between well wishing and a flat out lie. Your friend may be buying the insurance company b.s., but I know folks high up in the health insurance industry. The goal is to cut costs and create headaches, though they will never admit it outside a meeting that is not VPs and up. If that was true, every insurer would publish clear guidelines and post them on their website. They don't and even the UM people cannot explain the guidance clearly. Each insurer also has its own standards for EBP and medical necessity. How is that possible? Even after United Healthcare and other insurers have lost the fight and paid fines in multiple states. The answer is because the policy still makes money even after the fines. At the end of the day, the goal of a publicly traded company is to show quarterly profits, not provide generous healthcare subsidies.

Not sure we disagree. My post expressed a good deal of skepticism. But if the goal of the thread is to vent about how insurers are blanketly evil, my apologies.

Our insurance friends should meet.

 

[Sanman]

Not sure we disagree. My post expressed a good deal of skepticism. But if the goal of the thread is to vent about how insurers are blanketly evil, my apologies.

Our insurance friends should meet.

I never said they were blanketly evil. Simply that the goal of the insurance company is not to provide generous or proper healthcare. They are for-profit companies with the goal of retaining their capital. There is no social contract there. Their goal is to pay the least amount possible for only the most necessary care. Otherwise, they risk insolvency. Same goes not home or car insurance. They want to fix your stuff as cheaply as possible and only do so if no other party is found to be responsible.

 

[R. Matey]

I never said they were blanketly evil. Simply that the goal of the insurance company is not to provide generous or proper healthcare. They are for-profit companies with the goal of retaining their capital. There is no social contract there. Their goal is to pay the least amount possible for only the most necessary care. Otherwise, they risk insolvency. Same goes not home or car insurance. They want to fix your stuff as cheaply as possible and only do so if no other party is found to be responsible.

So, again, there's no disagreement. Notice I said, what it seems like it should be, not 'this is what the social contract is and, gosh, isn't it great?! By the way, have you ever read Ayn Rand? She actually makes some pretty good points!'

 

[Sanman]

So, again, there's no disagreement. Notice I said, what it seems like it should be, not 'this is what the social contract is and, gosh, isn't it great?! By the way, have you ever read Ayn Rand? She actually makes some pretty good points!'

It's been a while since a read Rand (HS and college). That said, Modern economic theory similarly assumes only self-interest.

 

[R. Matey]

It's been a while since a read Rand (HS and college). That said, Modern economic theory similarly assumes only self-interest.

You can safely assume that I understand economics. I do have a Ph.D. and I read a lot.

 

[WisNeuro]

You can safely assume that I understand economics. I do have a Ph.D. and I read a lot.

Considering the business/money decisions I see colleagues with PhDs making on a regular basis, I would not safely assume people are literate in economics, or even basic finances at this point in my life.

 

[R. Matey]

Considering the business/money decisions I see colleagues with PhDs making on a regular basis, I would not safely assume people are literate in economics, or even basic finances at this point in my life.

I'm editing out the snark in my post. I don't disagree in principle though given that I too have seen similar things from a few of my colleagues with Ph.Ds. Nevertheless, I'm not sure there's much wrong with giving someone the benefit of the doubt either.

 

[borne_before]

Considering the business/money decisions I see colleagues with PhDs making on a regular basis, I would not safely assume people are literate in economics, or even basic finances at this point in my life.

Do tell more!

 

[WisNeuro]

Do tell more!

Just simple stuff. Not understanding the difference between salary and overall compensation. Considering a job in private practice and a hospital system and taking the job in a hospital system at half the salary because they couldn't calculate that they could get their own health insurance that was better, and still be at like 180% of the hospital compensation. Doing a doctoral program that outs you in six figures of debt. Stupid things like that

 

[Sanman]

Just simple stuff. Not understanding the difference between salary and overall compensation. Considering a job in private practice and a hospital system and taking the job in a hospital system at half the salary because they couldn't calculate that they could get their own health insurance that was better, and still be at like 180% of the hospital compensation. Doing a doctoral program that outs you in six figures of debt. Stupid things like that

How about the general idea that we can't make more than $100k in income. One of the reasons I hang around here is that it is difficult to find a group of psychologists (or any other mental health professional) that is savvy enough to run a successful business or negotiate a decent salary.

Hell, school psychology is just as bad. I can name a ton of folks with PhDs working in the school system in the NYC area for $65k. You can maybe afford to rent out the closet of someone's Brooklyn apt at that salary (if you get a roommate).

 

[WisNeuro]

How about the general idea that we can't make more than $100k in income. One of the reasons I hang around here is that it is difficult to find a group of psychologists (or any other mental health professional) that is savvy enough to run a successful business or negotiate a decent salary.

Hell, school psychology is just as bad. I can name a ton of folks with PhDs working in the school system in the NYC area for $65k. You can maybe afford to rent out the closet of someone's Brooklyn apt at that salary (if you get a roommate).

The fact that someone can easily surpass this number, working part-time, and taking only Medicare, is something that is lost on people. And, the actual data to run these numbers is freely accessible. Anyone can do this simple math. I show people these numbers compared to what they're earning at their current work for the same workload and they look at me like I'm some sort of wizard. It's literally just multiplication and addition.

 

[Sanman]

The fact that someone can easily surpass this number, working part-time, and taking only Medicare, is something that is lost on people. And, the actual data to run these numbers is freely accessible. Anyone can do this simple math. I show people these numbers compared to what they're earning at their current work for the same workload and they look at me like I'm some sort of wizard. It's literally just multiplication and addition.

You definitely need a pointy hat and a cloak.

 

[Therapist4Chnge]

“I put on my robe and wizard hat…”