My wife and I have been in practice for many years. We have been quite successful in developing thriving practices as we have strong referral sources, including our prior patients. As a result, we usually get between 50 and 60 new referrals a month. In light of the number of referrals we receive, we have the ability to limit our practices to provide a high quality level of service. The down side is that most of the individuals who call us have to be referred elsewhere. These individuals have continuously told us that they cannot get a therapist on their insurance company list to take them on as new patients. We feel their discomfort and we also have been very frustrated with this situation. In our conversations with these individuals, we have encouraged them to complain to the source of this problem- their insurance companies.
The insurance companies have created this problem for what we think is their own financial gains. Most insurance companies have locked up their provider panels many years ago. They have not let mental health workers join the panels to keep control over their providers. It is our opinion that they have created roadblocks for subscribers to get access to mental health providers in order to reduce usage and ultimately save money.
Insurance companies have also created adversarial relationships with providers which has also served to reduce their costs, since providers would avoid accepting new managed care patients. It has been reported that non-insurance friendly psychologists (or those that do not go along with insurance company policies) have been blackballed or somehow do not come up on the computer screens when subscribers call 800 numbers for therapists in their area. Recently, Oxford Insurance Company audited 300 mental health worker's (100 psychiatrists, 100 psychologists, and 100 social workers) notes of patients from a few years ago. Oxford reviewed the session notes and demanded money back from almost all of the mental health workers. Oxford claimed they deserved the money back because they questioned the type, or duration of the session. It was very unlikely that almost all of the providers were unethical. After Oxford was threatened with, lawsuits they did back down and rescinded their auditing procedures and demands for reimbursement.
Insurance companies have put restrictions on therapists, required the release of confidential information in order to reimburse for therapy sessions, or have been failing to pay their bills in a timely manner. In addition, most insurance companies have not raised the fee structure since the 1980's. Some companies have not only kept the fees stagnant since the '80's but recently one company (GHI) has even reduced the fees for 2004 to an unacceptable level. Their attitude has been: accept our fees or leave the network. Our expenses have increased in the past 20 years and we cannot meet our bills if we cannot keep up with inflation.
Some psychologists have resigned from insurance panels to avoid ethical issues, procedural conflicts, or the low fees. It has been reported that insurance companies have sometimes not taken their names off the provider list to make the list look bigger. Other psychologists who do not resign will just refuse to take on new patients. If prospective clients call them, they claim they are all booked up or have no available spaces. They are essentially removing themselves from the provider list but not officially resigning. The outcome is that the managed care panels are really, what we call, "phantom panels". They look big, but they are filled with psychologists who no longer actively take clients. Phantom lists are good for the insurance companies because they can sell employers what looks like a good package of services and providers but not have to actually pay for the services.
It is our perspective that the insurance carriers are picking on the weak. Mental health services represent the smallest portion of the overall health care costs and users of mental health services represent approximately 5% of the total population of health insurance subscribers. Yet, this is the area where the insurers constantly cut. It would appear that mental health does not have true parity with medical health issues. In addition, those who use mental health services are generally not willing to be vocal to advertise their problems.
This problem will continue until employers, and subsequently insurance companies, get the message that subscribers are fed up with their tactics. We providers have no influence, since we do not pay premiums and we cannot financially affect the insurance companies' bottom line. Subscribers have all of the influence in this area. Subscribers need to call their human relations department, or those responsible for health insurance in their companies, and complain when they cannot find therapists on their respective insurance companies' provider list. Insurance companies have to realize that making money for their shareholders and executives will not continue if their business plan is built on denying services, restricting availability, or low balling fees.
If this problem continues, it would seem to us that the outcome will be that the that more seasoned, quality providers will drop out of the panels leaving newer or, possibly less capable providers. There could be a two-tier system, with the wealthy, who can afford to pay out of pocket, getting service from the seasoned providers, and the middle class and lower class will be left with the less experienced providers. So, help keep the "health" in mental health services by speaking to your insurance carriers and registering your dissatisfaction with their procedures and policies.