Why no insurance?!

The Big Question.... 

Why don't you take insurance?....We know. Its a bummer. You may have been excited about seeing a Prescriber in our practice. Maybe even warm and fuzzy. Until you got to the...(insert dramatic music)...Fees and Insurance page. But hang on. Don't log out just yet. Let us explain...

There are many reasons why Prescribers in psychiatry are opting NOT to participate in insurance panels. Nationally, 65% are in this category. And that number is sure to grow as it becomes more difficult to navigate the slippery slope of filing claims and getting fair reimbursement for services (or reimbursed at all).  So, here are some of the reasons CMH, LLC has chosen not to accept insurance:

1. Unfair/low reimbursement for services. You may believe this only affects our 'bottom line'. No. It absolutely affects the quality of your or your child's care. The answer to low reimbursement for many providers is....see more patients...and more patients. And the most common way to accomplish this is by adopting a "drive through psychiatry" paradigm. See patients for 3 minutes...5 minutes regardless of what is going on. Double booking is another way. This means potentially long waiting room times.

2. Conflict of interest - Our primary interest is for our patient's well-being. Working under the constraints of insurance companies sometimes puts providers in the position of having to choose between what is in their own best interest (ala # 1 above) vs the patient's best interest. We do not want to be in that position.

3. Restrictions - insurance companies may place restrictions on how often a patient is seen, or require prior authorization for visits. Activities such as checking insurance eligibility and obtaining prior authorizations is time consuming for the provider, or increases overhead costs if someone else is hired to attend to these tasks.

4. Privacy and Confidentiality - insurance companies require providers to disclose personal information to utilization review professionals

5. Additional Requirements - all providers document in their patient's legal record/chart; many of us limit this such as in sensitive personal information, but insurance companies also require additional documentation to justify the paying of claims (reimbursing the provider) that is not necessarily vital to understanding the patient needs and goals. This takes time. Providers must also take the time to educate themselves on how to be savvy documenters....online courses....seminars....we just want to see patients and help them get better...

6. The horrible, convoluted, slippery slope that is the insurance industry today, and not likely to get better any time soon.