Sunday, February 14, 2010

Are In-Network Shrinks Better Shrinks?

Clink and I have been having a discussion about insurance participation. It's for the book. We think.

So I've made the statement that given that insurance companies reimburse according to their somewhat random (and generally reduced) rate of Usual & Customary Fees, that they require paperwork and hoops to jump through, and that there is financial incentive for seeing a lot of patients in less time, more so then in giving slow and thoughtful care, that in some communities there is a force of natural selection and that the Best docs may be the ones who won't participate in insurance networks. Is this completely true: of course not. Some really good docs (especially inpatient and consult-liason, where there is very little option) participate with insurance companies. Maybe they live in communities where it's the only feasible way, maybe they like having high-volume practices, maybe they just participate with one or two selected insurance companies to accommodate select patients (or because they've heard the company is easy to work with, or reimburses well), or maybe they feel it's the socially responsible thing to do. Oh, or maybe they worry that if they Don't, they won't get enough referrals and make it in private practice.

So, in thinking about this, I realized I know very little about docs who participate with insurance networks. None of my friends do. I participated in Blue Cross for 7 years---they never sent me referrals and they'd send me random checks for $12.44 (like what was that a portion of?) or $44 something. The UCR was different for each patient, and they were all much much less than going fees back then.

I've been assuming that to make a living accepting insurance, that the doc needs to see a high volume of patients. That's not to say that a psychiatrist might not be willing to see a portion of their practice as psychotherapy patients and take a lower hourly fee for that, and compensate by doing high volume work the rest of the day, or by offering different levels of care based on insurance. That's not to say that there aren't psychiatrists who don't participate with insurance but still have very high volume practices, but they make a lot more money then I do (or so I believe).

But it's occurred to me that I really don't know much beyond what I learned when I was in a group practice way back when. If you take health insurance, tell me how your practice works-- how many patients do you see in an hour, do you get paid from the insurance companies, do you like your work, do you feel the care you give is as good? And if you see a psychiatrist in your insurance network, please tell us how that long are the appointments, how often do you go in, how does the billing and co-pay work? And if you've seen both in- and out- of network shrinks, how were they different and what worked better for you?