Re: Out of Pocket


Yeah, it's the same here.

Posted by: Moby Hick | Link to this comment | 07- 5-22 11:27 AM
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Hopefully my physical therapy is covered. It seems to be mostly kids care that's affected.

Posted by: Moby Hick | Link to this comment | 07- 5-22 11:36 AM
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Psychiatry does not take insurance, because the pay is too low. I've not heard of people not being able to get PT through insurance.

Posted by: Bostoniangirl | Link to this comment | 07- 5-22 1:37 PM
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Also, there is usually a different and separate out of network deductible.

Posted by: Bostoniangirl | Link to this comment | 07- 5-22 1:55 PM
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When I was searching for a therapist for my son, there were providers who took no insurance and ones who took only Medicaid, but it was very hard to find anything in between, even with a six-month waitlist. He eventually jumped the queue by being kicked out of preK. Very frustrating.

Posted by: Sand | Link to this comment | 07- 5-22 2:16 PM
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I have that rarest of creatures, a psychiatrist who takes not just insurance, but an ACA plan. It took a long time to get an appointment with her, during which interval I got my meds from a psychiatrist who takes every kind of insurance because she's bat-shit crazy and I presume that's the only was she can get clients.

Posted by: Sir Kraab | Link to this comment | 07- 5-22 2:45 PM
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6: my shrink said there are 3 reasons established therapists in private practice take insurance. Employed people in hospitals or health centers have different motivations, including academic advancement.

1. Because they have relationships with some long standing patients that they want to maintain

2. Because they want to give back/care about access for people

3. Because they don't think they will get patients otherwise.

You can do some of 1 and 2 with a sliding scale. That means that a lot of the people in category 3 stink. Which means, I would see someone who took insurance I found from a personal referral but would be nervous about going to my insurance company's list*

Tim went to a therapist who took the insurance my hospital provides. The nice social worker at the EAP gave us the name. The guy was pretty weird. One day he pulled out a nail clipper and cut his nails during a session. Definitely fell into category 3.

Posted by: Bostoniangirl | Link to this comment | 07- 5-22 2:59 PM
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Back when we were trying to figure out what was up with my kid, every psychiatrist and therapist in our city stopped taking our insurance. We ended up having to drive 70 miles to find a (terrible, sucky, awful) psychiatrist who took the insurance.

The kid's therapist offered to keeping seeing the kid for, essentially, free (the copay, which was thirty bucks); but luckily we found a wonderful therapist only 50 miles away who took the insurance.

All this to say yeah, it's a fucking nightmare.

Posted by: delagar | Link to this comment | 07- 5-22 8:09 PM
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Yep. Insurance pay rates and requirements are horrible. Not enough graduates either.
Recent findings in VA:

A large and disproportionate number of Virginia's licensed BH professionals are at or nearing retirement age (61% of Psychiatrists are age 55 or older).
93 of Virginia's 133 localities are federally-designated Mental Health Professional Shortage Areas; 37% of Virginians (3.2 million) live in them. Two localities have no licensed BH professionals; 35 have no trained BH prescriber (Psychiatrist, Psychiatric-Mental Health Nurse Practitioner).
Virginia's BH workforce does not reflect the racial and ethnic diversity of the Commonwealth's population.
In many communities with no or a few BH professionals, a large number of households do not have broadband internet access and are unable to access tele-health services. One-in-five Virginians (20%) live in these communities.
Virginia localities with no or a few BH professionals have poorer outcomes on key BH indicators than localities with more BH professionals.
Although Virginia's 40 graduate-level BH programs, combined, graduate nearly 800 individuals annually, the number who ultimately become licensed is insufficient to maintain even the current inadequate supply of BH professionals.

Posted by: will | Link to this comment | 07- 6-22 5:10 AM
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This is definitely a thing, and it's bad. My insurance is pretty good and I've learned the hoops for submitting for reimbursement, but it's still a hassle and the first step of finding people is challenging.

One of the (many!) ways it's a problem is in depression treatment: needing to pay out of pocket can a trigger "oh, that's too much, I'm not worth it" reactions, even when it's technically affordable, leading people to stick with bad practitioners or no treatment at all.

Posted by: Nathan Williams | Link to this comment | 07- 6-22 5:56 AM
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Out of network is tricky because of the usual and customary rate stuff which is less than what they pay contracted providers. So, someone charges $150/hr, and the insurance rate is $100, but the UCR is $75. After the deductible, insurance will cover 70% of the $75, so you're still paying $100.

The insurer my hospital switched to when they dropped Blue across paid Medicare rates for outpatient mental health. I am generally not sympathetic to the idea that Medicare grossly underpays, but in the case of mental health providers - especially therapists, it's entirely warranted. And nobody takes it. I think people take Medicaid in clinics, because that's where kids get treatment and they are often covering all kinds of other services that are not just office-based therapy that are not covered by private insurance, so the clinics get by but lose money on the individual therapy visits.

Posted by: Bostoniangirl | Link to this comment | 07- 6-22 6:22 AM
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My impression is that these providers used to accept insurance, or would like to accept insurance, if the insurance industry didn't make it so impossible and time-consuming and infuriating for them.

This isn't exactly the situation with the midwife center, but dealing with insurance companies is just a massive time suck every step of the way, and there's simply no such thing as having a good working relationship with them. It's just purely a matter of how much bullshit and misery is involved.

Posted by: JRoth | Link to this comment | 07- 6-22 6:23 AM
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A friend of mine adopted 2 sibling pairs through DCF and those kids got to keep their MassHealth coverage, which was much more generous than private insurance would have been and all the hospital affiliated docs take it.

Posted by: Bostoniangirl | Link to this comment | 07- 6-22 6:23 AM
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I have excellent health insurance through state employment. Our experience with psycho docs et al for various kids and family therapy (marriage counseling) was that they all, always make you pay at the time of service and then you have to file for reimbursement. PT coverage is excellent and just about all the local providers accept it. Acupuncture and chiropractor were/are covered though they demand payment at time of service like the psycho docs and the patient has to file for reimbursement (rules change -- at one point it was unlimited chiropractor even without a doctor's prescription, which I assume means that either some very powerful politician had a chiropractor in the family or they have the absolute best lobbyists).

I recall at one point having an $850/month COBRA charge for one of the kids and still having to pay upfront the ~$150 per weekly session with the very special homeopathic* psychiatrist and then filing the claims for reimbursement (*maybe he was a naturopath psychiatrist).

We had two kids who at one time had serious issues, plus the normal health stuff for the other three, plus my wife with acupuncture and chiropractor, and I'm almost giddy at this moment as I am reminded that I no longer have to spend >20 hours a month doing the spreadsheets to keep track of it all.

Posted by: No Longer Middle Aged Man | Link to this comment | 07- 6-22 7:42 AM
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14: Our state insurance is crap. Towns and cities used to have good coverage but they had to join the state plans to save money, so even if you have Tufts for medical, they carve out behavioral to Beacon (which is a Medicaid managed care group) and few people take it.

Posted by: Bostoniangirl | Link to this comment | 07- 6-22 7:55 AM
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6. Is this widely accepted to be true? I'm trying to find a therapist and, although I have very good insurance through my employer, I am having a lot of trouble finding an in-network provider. I'd really like to find someone within my plan, because of course it's always nice to pay less money out of pocket, and also because I have never had a successful experience of therapy* and I hate spending hundreds of dollars to waste my time. The unproductivity of therapy would make me so much less anxious if it wasn't also so expensive. But obviously, if cheapness is going to guarantee unproductivity, I'd rather try a more expensive option.

*Like, I've tried maybe half a dozen therapists over the past twenty years (IIRC, all paid out of pocket?), with the longest continuous relationship being about six months, and it has never not felt like a total waste of time. At this point it does seem as though the problem might not be the therapists, but me, or maybe my approach to the process. But I'm kind of having a bad time right now and so I'm trying to try again.

Posted by: jms | Link to this comment | 07- 6-22 12:45 PM
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I can basically never leave my employer, both for academic job market-related reasons and also because the insurance is so good. I pay five times what the other plans cost to use a PPO, but that amount is still super reasonable, there's no deductible, and everyone I've ever wanted to see has been covered (including my psychiatrist, who is excellent). In the past I've had therapists who have stopped accepting insurance, but that's typically been as they were winding down their practices en route to retirement, and they both were willing to do a sliding scale for established clients. I've rarely had to pay upfront for anything except co-pays, and I'm a fairly heavy user of the system. The advantages of working for a state school in a blue state with a great union bargaining team are unreal, and it's ridiculous that this level of access isn't available to everyone.

Posted by: J, Robot | Link to this comment | 07- 6-22 2:10 PM
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16 should refer to comment 7, not 6

Posted by: jms | Link to this comment | 07- 6-22 2:20 PM
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The one annoying thing is that part of what makes this affordable is that spouses are only covered if they certify each year that their own employer does not offer health insurance. Mr. Robot therefore has coverage through his own job--same instance company, crappier coverage.

Posted by: J, Robot | Link to this comment | 07- 6-22 2:21 PM
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18: Therapists are so hit-or-miss that I've always prioritized word-of-mouth recommendations when it's been possible. If you don't feel comfortable asking friends, your GP or other medical providers may have a decent sense of who is good and taking new clients. When that hasn't been possible, I've used Psychology Today's search engine, narrowing options down by treatment modality and insurance coverage.

Posted by: J, Robot | Link to this comment | 07- 6-22 2:27 PM
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16: I think it depends on the region. But Boston, New York and probably SF have many people who drop insurance., because there are people who can and will pay The sickest people get young, inexperience social workers who aren't fully licensed. Some are wonderful, but they often leave. Others work part time for hospitals or community agencies to get benefits, but in their private practices, they don't take insurance. It could be totally different elsewhere. Many of those places are really underserved. Wyoming might have only one psychiatrist.

16: If you want something quick like CBT, you might be more likely to find someone who works well with insurance. If it's deeper stuff like trauma, that requires longer term care, that is less quantifiable it's harder.

20: I think asking therapist friends is your best bet. My hospital used to have embedded social workers who gave names, now they are trying to do IMPACT behavioral activation, and there is a centralized resource for referrals to community therapists, but I would trust Psychology Today more, and I know some docs recommend it. The PCPs I know give names of clinics that they know take insurance, but don't have names of specific therapists and aren't up on who takes what insurance. They are also being asked to do more prescribing - even for things like bipolar (type 2) which previously would have been referred to psychiatrists. They can get e-consults for help and the sickest or patients with sub specialty issues like postpartum care can be seen by a psychiatrist.

Posted by: Boatoniangirl | Link to this comment | 07- 6-22 2:46 PM
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I have to imaging what constitutes a 'good therapist' varies wildly for different patients.

Posted by: Yoyo | Link to this comment | 07- 6-22 2:53 PM
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22: Yes. The question of fit is hard to figure out in a scientific way. But I am equally confident that there are some people who are objectively bad. Like pornography, you know it when you see it.

Posted by: Bostoniangirl | Link to this comment | 07- 6-22 3:17 PM
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You especially know bad pornography when you see it.

Posted by: heebie | Link to this comment | 07- 6-22 4:09 PM
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Both involve close relatives.

Posted by: Moby Hick | Link to this comment | 07- 6-22 4:15 PM
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Awkward, unconvincing speech and too much of it.

Posted by: heebie | Link to this comment | 07- 6-22 5:54 PM
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