There appears to be a lot of confusion about managed care, and with confusion comes inertia. We see it playing out on a National level so of course it is effecting us on a local level. The reality is that not much has really changed in the scope of things. Insurance companies still reimburse for "out of network" service although the deductibles have begun to vary greatly over the years from one provider to the next.
Finding a therapist on a list is similar to looking in a phone book these days and can be quite daunting. The other difference is that "in network" reimbursement rates have declined dramatically in the last few years as well; which partially explains the exodus of medical and psychiatric providers from many high profile insurance panels. Not to mention that finding a therapist on a list is similar to looking in a phone book these days and can be quite daunting.
These are two primary reasons, along with practice freedom that many doctors choose not to deal with the bureaucracy and unnecessary oversight of having to justify every medical or psychiatric decision by disclosing patient confidential information repeatedly to insurance companies.
These are two primary reasons, along with practice freedom that many doctors choose not to deal with the bureaucracy and unnecessary oversight of having to justify every medical or psychiatric decision by disclosing patient confidential information repeatedly to insurance companies.
Another unfortunate problem is the language regarding out of pocket expenses; co-pays -vs- co-insurance payments, as well as deductibles. Until there is a universal deductible for mental health the confusion and rate wars will continue. Speaking for myself, as an "out of network provider" I charge a fair market rate that clients either find agreeable or not. It is lower than many of the in network practitioners charge the insurance companies, but they balance it out once their rate drops following the client meets the insurance deductible.
However, on a personal note, I do not reveal (without your permission) your reasons for treatment and your notes to your insurance company for any reason. I release the minimum amount of information necessary for you to be reimbursed for your costs, if you want to be reimbursed. Many clients prefer remaining confidential in their treatment and choose not to be reimbursed.
Not everyone can afford not to be reimbursed however, so, confidentiality remains a major sticking point between "in network" vs "out of network." Confidentiality is less secure when you work on a panel because the insurance company can audit your file when they feel fit to do so. So one of the benefits you are paying for is the luxury of privacy with an "out of network" provider. You are able to feel confident that your information is kept private and not shared with your insurance company, unless you want it to be.
A bargain is not always the best or wisest course of action. It does work for many, but many "out of network" providers have sliding scales to work with clients and make "out of network"treatment more accessible to more people. Don't be afraid to try to negotiate a rate with a provider, It can't hurt and may help you get a better therapist in the long run.
As always I hope you found this helpful and informative. Feel free to contact me for consultations.
All the Best,
Dr Kevin
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