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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Lisa Simpson on November 2, 2000, at 5:31:47
I've heard the term "pdocs" used here lots of times. Can someone tell me, does that stand for psychiatrist? Silly question, I know, but I'm not sure how things are done outside of the UK.
Can you find yourself a pdoc or do you have to be recommended by your doctor? And if you can find your own one, does he have to keep your doctor (GP) informed about the treatment he's providing?
Thanks for your help!
Lisa
Posted by Bill L on November 2, 2000, at 7:58:09
In reply to Pdocs, posted by Lisa Simpson on November 2, 2000, at 5:31:47
Lisa- A pdoc is a psychiatrist. Whether or not you need your doctor's permission to see a pdoc depends on your health insurance coverage if you live in the USA. Since you live in the UK, different rules apply. I'm not familiar with the UK's national health rules. You should ask your regular doctor about that.
In all cases, your pdoc should keep your GP informed especially if the pdoc puts you on medication. That's because medications react with each other. In the US, lots of GP's as well as pdocs treat depression. If psychotherapy (talk therapy) is needed, then it's better to go to a pdoc.
> I've heard the term "pdocs" used here lots of times. Can someone tell me, does that stand for psychiatrist? Silly question, I know, but I'm not sure how things are done outside of the UK.
>
> Can you find yourself a pdoc or do you have to be recommended by your doctor? And if you can find your own one, does he have to keep your doctor (GP) informed about the treatment he's providing?
>
> Thanks for your help!
>
> Lisa
Posted by Greg on November 2, 2000, at 8:16:23
In reply to Re: Pdocs, posted by Bill L on November 2, 2000, at 7:58:09
Lisa,
Bill is on the money about this. I just wanted to add that Mental Health services are generally the exception rather than the rule when it comes to health insurance (at least here in the states). I have excellent insurance coverage (PPO), and I don't need a referral for anything except Mental Health. I had to get referrals and authorization for both my therapist (talk therapy), and my psychiatrist (prescribes my meds).
Greg
Posted by noa on November 2, 2000, at 8:29:08
In reply to Pdocs, posted by Lisa Simpson on November 2, 2000, at 5:31:47
It may be that people are using "pdocs" to mean slightly different things.
Me? When I write "pdoc" I am referring to my psychiatrist, who specializes in psychopharmocology. I see him once a month. I also see a psychotherapist twice a week--he is a psychologist.
In the US, access to "pdocs" varies by what type of insurance you have. Many people have "managed care" types, as in HMO's (Health Maintenance Organizations) or PPO's (Preferred Provider Organizations) for example. In managed care, you usually have what is called a "primary care" doctor, who is like a gatekeeper to any specialties. So, in order to see any specialists, you might have to get a referral from your primary care physician. However, primary care doctors often are burdened with disincentives for referring to specialists. In addition, the managed care companies pose restrictions on how many visits to specialists, and often offer an extremely limited list of specialists who belong to the managed care plan. As a patient, you might spend a lot of time on stupid paperwork just to be able to see a specialist---requesting a referral, going to pick up the referral, etc.
With mental health, a lot of managed care companies use behavior health management subcontractors to do the gatekeeping. This often involves calling someone and telling them why you need to see a mental health professional, and they determine if you do need it, and how many visits they approve. To continue after these first visits end, you have to get reauthorization from this behavior health management co. And, usually, the pdoc or other mental health professional has to jump through tons of hoops to please them, writing reports, answering all kinds of beuraucratic questions, setting specific goals and timelines for treatment, etc. The pdocs, et. al, end up spending more time on this stuff than on seeing patients--it is ridiculous. More and more pdocs are joining big group practices so they can pool their administrative resources to deal with managed care. But then, you feel more and more like you are dealing with a clinic environment and less like visiting a private doctor.
In the managed care model, it is often the case that the specialist then has to write a report to the primary care doctor about the treatment.
On the other hand, if you have a more open insurance plan, you can choose any doctor you would like. If they are a participant in your insurance, the doctor often does the paper work, and you pay the doctor your portion, and they bill the insurance for the rest. But usually, you have to pay the doctor and then submit bills to the insurance company for reimbursement. Non-managed care plans are usually a good deal more expensive, and are often not offered as a choice to employees. Oh yes, that is a key factor in US health care---health insurance is often provided through the employer. It used to be that many employers paid all or most of the cost, but over the years, more and more employees pay increasing shares of the cost of insurance. YEt, we are still restricted to the choices offered through our employers. Getting insurance through such a group makes sense, tho, because groups can negotiate better deals than individuals. BUT, this leaves the employee with limited choices.
One problem here in the US is that insurance companies often don't provide the same amount of coverage for mental health as they do for other health care. Since insurance is regulated at the state level, some states do require what is called parity for mental health services, but other states do not. So, you might have a good insurance plan with liberal coverage for most things, but limited coverage for mental health. Sometimes, you might have a regular (non-managed care) insurance, but with managed care just for mental health.
Usually, managed care pays for medication management but only limited therapy.
Still another issue is that more and more pdocs are not participating with any health insurance plans, leaving the patient to pay either the entire fee themselves, or having to pay and then request reimbursement from their insurance. But, the insurance will reimburse a percentage of what THEY believe the doctor should charge, not what the doctor actually charges. For example, if the pdoc charge $200 for an initial evaluation, the insurance company might pay 75% of what they deem "usual and customary" fees, which may be something in the range of $110, for instance (it varies by location), leaving the patient to pay the majority of the cost.
The reason these pdocs are not dealing with insurance anymore is pretty obvious--if there are people who will pay the full fee in cash, why would they accept a much lower amount(if you are on a plan, you are not allowed to make the patient make up the difference between the fee and what the insurance feels the fee should be), and have to get bogged down in paper work, etc.?
But, this leaves us with a two tiered system--private docs for those who can affort it, and docs who participate in insurance and are therefore affordable. BUT, sometimes the choice of docs is extremely limited and those practices are packed, making it hard to get appointments, and making communication with the doctors quite difficult.
Others here may have more info and insight to explain our system.
Also, you might like to see the web site of the Coalition of Mental Health Professionals and Consumers:
www.nomanagedcare.com
Posted by Lisa Simpson on November 2, 2000, at 11:13:02
In reply to Re: Pdocs, posted by noa on November 2, 2000, at 8:29:08
Hi - thanks everyone for your responses - especially noa's book on the subject! :)
I guess I really need a response from someone else in the UK (are there any of you out there?) as generally we don't need insurance in the UK, unless you go private. So I don't think I can find myself a pdoc, I need to be referred to one by my GP. That's what I think... unless, of course, someone knows better!
Thanks all for your speedy response... you guys are great!
Greg, you know you offered to communicate to me via email? Well, I haven't really taken you up on that because my other half has access to my email, and I don't want him to know about my visits to this board. So I wondered, would you be prepared to have a chat on the phone sometime re: the alcohol thing? I can call overseas from work, no problem. If you feel you can do that, perhaps you could email me your phone no. But I'll understand, of course, if you don't want to do that! It's just that I have no one to talk to... and I'd really like to hear a human voice rather than just words on my screen...
Lisa
Posted by JahL on November 2, 2000, at 12:34:02
In reply to Re: Pdocs - to all here (pls read, Greg!), posted by Lisa Simpson on November 2, 2000, at 11:13:02
> Hi - thanks everyone for your responses - especially noa's book on the subject! :)
>
> I guess I really need a response from someone else in the UK (are there any of you out there?) as generally we don't need insurance in the UK, unless you go private. So I don't think I can find myself a pdoc, I need to be referred to one by my GP. That's what I think... unless, of course, someone knows better!Hi Lisa.
Over here in the UK you do have to obtain a referral from your GP, who will generally direct you to a psychiatrist/psychologist based at your nearest psychiatic unit.
Unhappy with the pdocs I was being refered to (unfortunately your choice, if one exists, of who you might be refered to is restricted by who yr GP knows), I recently tried to track down the name of a pdoc who specialised in TRD. I was told in no uncertain terms by a number of (supposedly help) organisations that all referrals must come through yr doctor and that I had no place seeking such information (!?!)
If you manage to track down someone who might be helpful in this area, I'd like to know!
Good luck,
Jah.
Posted by noa on November 2, 2000, at 14:34:46
In reply to Re: Pdocs » Lisa Simpson, posted by JahL on November 2, 2000, at 12:34:02
what if you dug up some names yourself, could you ask the GP to refer you to that pdoc?
Perhaps university-affiliated hospitals where there are pdocs who are "on the cutting edge"? Maybe you could look at research articles for clues as to some docs who do clinical research who are up to date on psych meds.
Posted by Greg on November 2, 2000, at 15:16:36
In reply to Re: Pdocs - to all here (pls read, Greg!), posted by Lisa Simpson on November 2, 2000, at 11:13:02
Lisa,
Absolutely not a problem. I have your e-mail at home and will send you the number this afternoon. I think I'm about 8 hours ahead of you and I get in to work about 1pm your time. Call when you're feeling up to it.
Greg
Posted by JahL on November 2, 2000, at 16:54:11
In reply to Re: Pdocs, posted by noa on November 2, 2000, at 14:34:46
> what if you dug up some names yourself, could you ask the GP to refer you to that pdoc?
Yes.
> Perhaps university-affiliated hospitals where there are pdocs who are "on the cutting edge"? Maybe you could look at research articles for clues as to some docs who do clinical research who are up to date on psych meds.
Good ideas. With me it's a case of getting off my lazy, amotivated arse. I've just (finally) been referred to Maudsley, the top UK depression hospital (any UK folk any experience of this place?) but I'll get on the case in case this doesn't work out.
Thanks,
Jah.
Posted by noa on November 2, 2000, at 17:12:48
In reply to Re: Pdocs, posted by JahL on November 2, 2000, at 16:54:11
Jah, it's tough, isn't it?
In order to get quality care for depression, we have to take initiative, be assertive, reach out, follow through, etc., ie, all the things that are hard to do when you are depressed.
Posted by JohnB on November 4, 2000, at 12:56:16
In reply to Re: Pdocs » Lisa Simpson, posted by JahL on November 2, 2000, at 12:34:02
> Over here in the UK you do have to obtain a referral from your GP, who will generally direct you to a psychiatrist/psychologist based at your nearest psychiatic unit.
>
> Unhappy with the pdocs I was being refered to (unfortunately your choice, if one exists, of who you might be refered to is restricted by who yr GP knows), I recently tried to track down the name of a pdoc who specialised in TRD. I was told in no uncertain terms by a number of (supposedly help) organisations that all referrals must come through yr doctor and that I had no place seeking such information (!?!)-Yikes! I'm sorry to read this. To be directed to "your nearest psychiatric unit". Is this what happens when the government runs the health care system? There are many here in the USA who wish for gov health care, but they should read this.
Posted by JahL on November 4, 2000, at 14:40:31
In reply to Re: Pdocs - UK, posted by JohnB on November 4, 2000, at 12:56:16
>
> > Over here in the UK you do have to obtain a referral from your GP, who will generally direct you to a psychiatrist/psychologist based at your nearest psychiatic unit.> -Yikes! I'm sorry to read this. To be directed to "your nearest psychiatric unit". Is this what happens when the government runs the health care system?
Unfortunately yes.
> There are many here in the USA who wish for gov health care, but they should read this.Bear in mind also that the waiting lists, inherent in any govt-run health system (since resources must be 'rationed'), often mean a 3 month wait for a depressed person's first pdoc appointment. This was so in my case.
'Free' health-care does have its advantages tho'. The care may be crap but at least everyone has access to it!
Jah.
Posted by JohnB on November 4, 2000, at 19:03:19
In reply to Re: Pdocs - UK, posted by JahL on November 4, 2000, at 14:40:31
> Bear in mind also that the waiting lists, inherent in any govt-run health system (since resources must be 'rationed'), often mean a 3 month wait for a depressed person's first pdoc appointment. This was so in my case.-Since many depressive episodes have run their course in 3 mos, this is supreme irony.
> 'Free' health-care does have its advantages tho'. The care may be crap but at least everyone has access to it!
-Yeah, If you're hit by a car it's good, but doesn't sound so good for depression. And then there's those taxes you guys pay. I remember reading that as soon as the Rolling Stones started making big money, they changed their citizenship. They're citizens of . . . . Monaco? . . . . . The Bahamas?
Posted by noa on November 5, 2000, at 9:58:54
In reply to Re: Pdocs - UK, posted by JohnB on November 4, 2000, at 19:03:19
www.nomanagedcare.com has articles about alternatives to the current US system that aren't government-run either (eg--collectives that people can join to purchase insurance together, rather than relying on employers to choose the plans). You might be interested in reading about them.
Posted by Lisa Simpson on November 6, 2000, at 8:21:27
In reply to Re: Pdocs - UK, posted by noa on November 5, 2000, at 9:58:54
Can anyone tell me, do you pay for your pdoc in the States, or does it come under your insurance? I was recommended by my GP to a therapist who was supposed to be top in his field - he has written several books on the subject. But he was charging £90 a one-hour session (approx. $135), which I couldn't afford... certainly not on a regular basis. So I just saw him the once.
We may be taking out private medical insurance at work (BUPA), but as I understand it, this wouldn't cover psychiatric treatment of any sort.
I didn't really take to the guy either, and I would guess you would need to like your pdoc or you wouldn't be able to get a rapport with him. He was ever so serious, and didn't appear to have a sense of humour. Which for me at any rate would be important.
Lisa
Posted by chdurie2 on November 6, 2000, at 18:59:41
In reply to Re: Pdocs - UK, posted by Lisa Simpson on November 6, 2000, at 8:21:27
> Can anyone tell me, do you pay for your pdoc in the States, or does it come under your insurance? I was recommended by my GP to a therapist who was supposed to be top in his field - he has written several books on the subject. But he was charging £90 a one-hour session (approx. $135), which I couldn't afford... certainly not on a regular basis. So I just saw him the once.
>
> We may be taking out private medical insurance at work (BUPA), but as I understand it, this wouldn't cover psychiatric treatment of any sort.
>
> I didn't really take to the guy either, and I would guess you would need to like your pdoc or you wouldn't be able to get a rapport with him. He was ever so serious, and didn't appear to have a sense of humour. Which for me at any rate would be important.
>
> Lisalisa-my p-doc, who is in a suburban area outside New York City (major big American city docs usually charge more) charges me $160 (American dollars) for 45-minutes. his normal rate is $175 for the same time - he gives me this small discount cuz i have not been working for a while.
he takes no insurance plans and will not do your insurance paperwork - but he bills me monthly, with payment due 30 days after he gives me the bill. this gives me plenty of time to submit the bill to my insurance company, who pays 75 percent of each visit up to a total of $5,000 a year paid out (not the doc's total) with a $25,000 lifetime maximum. BUT...there's another clause in the policy that says i only have to pay $3,000 total out of my pocket for any covered medical expense per year - after that they pay 100 percent of everything they deem acceptable. and they're pretty reasonable, but they won't pay for any alternative medicine stuff. i have high medical bills every year, so the reality is that fairly early in the year they start paying 100 percent of my p-doc bill, and so far this year they have not "cut me off" in spite of the fact that i'm pretty sure i'm already over the $5,000 limit this year.
also, my p-doc is a psychiatrist, and there's a fairly new law in my state that psychiatrist visits for medication purposes must be handled at the same payable benefit rate as other MD's. (insurance companies frequently pay a lower percentage for psychiatrist visits than for other docs.) but mine hasn't used the "medication billing" code cuz he says it won't help me get money. since the insurance company hasn't given me any problems, i haven't argued that one with my p-doc.
yes, even in the U.S., therapy is frequently expensive.
my p-doc also will return any telephone call during business hours, usually within the same day, always so if it's important. and he returns any "emergency" call made to his pager usually within an hour - emergency is defined loosely as long as i don't abuse it. and if i have requested a second session during a week but he doesn't have the time available, he will usually spend 10-15 minutes on the phone with me at no charge, if i need it.the psychiatist i saw in new york city at a major hospital/sleep disorder clinic charged $200 an hour to treat my sleep problems but would take no phone calls inbetween visits. and insurance considered his visits like a regular md, so it didn't get charged to my "psych budget." so there are a few ways around the psych budget limitation.
hope that helps.
caroline
Posted by Cindy W on November 6, 2000, at 21:56:28
In reply to Pdocs, posted by Lisa Simpson on November 2, 2000, at 5:31:47
> I've heard the term "pdocs" used here lots of times. Can someone tell me, does that stand for psychiatrist? Silly question, I know, but I'm not sure how things are done outside of the UK.
>
> Can you find yourself a pdoc or do you have to be recommended by your doctor? And if you can find your own one, does he have to keep your doctor (GP) informed about the treatment he's providing?
>
> Thanks for your help!
>
> LisaLisa, I was originally referred to my pdoc by my "gatekeeper" general MD, who is an internist. Since then, I found out I could have gone to him directly, through a contracted-out mental health provision of my insurance. He offers med management and psychotherapy and is a truly wonderful human being. I just wish I could see him more often! He is so in demand that he is booked solid for a month at a time. He has really helped me a lot!--Cindy W
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