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Dr. Bob is Robert Hsiung, MD,
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Posted by Phillipa on July 25, 2011, at 20:56:38
Even if a person has private insurance seems a lack of services for Patients. Lack of docs seen as big cause. Phillipa
Access to Urgent Psychiatric Care Severely Limited
Even Patients With 'Excellent' Private Insurance Left Out in the Cold
Fran LowryAuthors and Disclosures
July 25, 2011 A preliminary study has confirmed the authors' worst suspicions that access to outpatient psychiatric care, even for privately insured patients who have been referred by emergency departments, is severely limited.The study, available online, is also to be published as a letter to the editor in the August print edition of Annals of Emergency Medicine.
"As Massachusetts clinicians caring for patients with mental illness, we experience frequent difficulties obtaining psychiatric care for our patients," write J. Wesley Boyd, MD, PhD, from Cambridge Health Alliance and Children's Hospital Boston, Massachusetts, and colleagues. "But how bad are things really?"
Dr. J. Wesley BoydTo find out, Dr. Boyd and his team posed as patients insured by Blue Cross Blue Shield of Massachusetts PPO, the largest insurer in Massachusetts. They called every in-network mental health facility within a 10-mile radius of downtown Boston, claiming that they had been evaluated in an emergency department for depression and then discharged with instructions to get a psychiatric appointment within 2 weeks.
Only 8 of the 64 facilities listed by Blue Cross as preferred providers offered appointments, and of these, just 4 offered an appointment within the recommended 2-week time frame.
Twenty-three percent of the facilities never even bothered to call back, despite 2 telephone calls from the supposedly depressed patients.
Another common reason appointments were unavailable was that 23% of psychiatric providers required that the patient already be enrolled with a primary care physician affiliated with their psychiatric facility.
Money Loser
"We didn't think it would go too well, but we were really surprised at just how bad it was," Dr. Boyd told Medscape Medical News. "Given that we used what we thought was a very good private insurance, one that didn't require prior authorization, to be able to get only 8 appointments out of 64 and only 4 appointments within 2 weeks, it was pretty sad."
Dr. Boyd said that psychiatry is a money loser for institutions, and as a result, facilities do all they can to limit the amount of psychiatry services they offer.
"That's why they put in all these stipulations, like you can only be seen here if you have a primary care doctor within our system. If you're getting a titanium hip replacement, have you ever heard of there being a requirement that you must have your primary care doctor at the same facility where that surgeon is operating? No, because it's a huge money maker. They'll fly you in from out of state to get a titanium hip replacement," he said.
One step toward improving this situation would be to improve reimbursement for people who provide psychiatric services.
"I think one measure of the humanity of a society is how well it takes care of its most needy, and psychiatric patients often cannot advocate for themselves. They have gotten a short shrift. Managed care has hit psychiatry harder than any other discipline in medicine," he said.
Dr. Boyd also noted that separating psychiatric coverage from most insurance plans is another factor making it difficult for people to access care.
"We want to highlight the problem and alert people in hopes that psychiatry as a discipline will become better respected and therefore reimbursed better, which will open up access. The other message we want to stress is merely having insurance is no guarantee that you are going to have access to services," he said.
Shortage Specialty
Commenting on the study for Medscape Medical News, Carolyn B. Robinowitz, MD, a psychiatrist in private practice in Washington, DC, and a former president of the American Psychiatric Association, said the study highlights the lack of availability of psychiatric services in general.
"The article shows that we are a shortage specialty. There aren't enough of us, and we have to do some things to improve our accessibility and availability," she said.
"These numbers are disconcerting," Dr. Robinowitz agreed. "As these ACOs [accountable care organizations] and other systems are developed, the challenge is going to be try to use mental health providers, psychiatrists, social workers, and psychologists to work together so that the solo practitioner seeing patients is not quite so isolated," she added.
Dr. Robinowitz also said that currently there is no system in place in the United States for urgent care.
"This lack of a system probably feeds into the lack of availability. So it is probably a combination of economics, or poor reimbursement for psychiatric care, as well as a system problem.
Dr. Boyd and Dr. Robinowitz have disclosed no relevant financial relationships.
Ann Emerg Med. Published online July 21, 2011
Posted by policebox on July 26, 2011, at 1:41:36
In reply to Private Insurance Access To Psych Care limited, posted by Phillipa on July 25, 2011, at 20:56:38
Thank you for the article. It's long past the time when insurance companies should stop segregating "mental health" treatment within their policies.
I think it's ironic that insurance companies have been more open to accepting "alternative medicines" and are willing to make payment toward other disciplines which I'd consider to be pseudosciences or frauds, but yet they make seeing a psychiatrist with an MD or a psychologist with a PhD difficult.
What a world...
Shannon
Posted by jedi on July 27, 2011, at 0:07:27
In reply to Private Insurance Access To Psych Care limited, posted by Phillipa on July 25, 2011, at 20:56:38
Hi Phillipa,
I assure you the situation is much worse in less populated areas of the country. The small city I live in is supposed to be the regional medical center for the entire central part of my state. There are hundreds of doctors that practice in various public and private hospitals and clinics. There are maybe two or three psychiatrists that practice in the area. There is one listed in the yellow pages. From where I live, you can count on driving 150 miles to even see a PDOC. You actually have a better shot at seeing a psychiatrist, in my town, if you have no insurance. The very few that do work in this area are in the government subsidized clinics.
Take care,
Jedi
Posted by bleauberry on July 27, 2011, at 16:13:35
In reply to Private Insurance Access To Psych Care limited, posted by Phillipa on July 25, 2011, at 20:56:38
Interesting article. Sad too.
Most people who have not paid attention to the small print are in for a very rude awakening when they discover Obamacare will make this all even worse and cost us personally more than we now pay.
That is, if there is anything left.
The topic of psychiatry makes it even more difficult and cloudy. It's just such an unscientific experimental field I don't think anyone is going to give it front row seats.
Posted by Phillipa on July 27, 2011, at 19:20:48
In reply to Re: Private Insurance Access To Psych Care limited, posted by bleauberry on July 27, 2011, at 16:13:35
Blue don't get me going on Obamacare. The situation is will be even worse if he decides not to send out social security checks on Aug 3. No one will have funds for food etc. Meds will hit the wayside and definitely no supplements. Those on it will enter the great depression of the 20's again in my opinion. Phillipa
Posted by Jane D on July 28, 2011, at 10:44:04
In reply to Re: Private Insurance Access To Psych Care limited, posted by bleauberry on July 27, 2011, at 16:13:35
This is the end of the thread.
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