health reform from a provider's perspective

Here's what I'm seeing in my practice. I've been doing this for ten years now. Long enough to declare a trend.

And no, stodgy research types, I don't need to conduct a double blind placebo trial in order to render opinions of substance. This is my peer reviewed blog.

Copays are going up. When I first started, the $15 copay was routine. Maybe the copay of highest frequency. I even saw a few $10 copays. Copays of $20 and $25 were the next most routine. But now? The most frequent copay has inched up (and by that I mean, nearly doubled) to $30 and $35. I have a few people who pay $50 per visit. And yes, that's a copay. And I haven't seen a $10 copay in years.

Deductables are higher. And I'm seeing them more often, too. When someone comes in for psychotherapy, especially for the first time, they mistakenly believe their mental health copays and deductables will be the same as a visit to the medical doctor. But the reality is that most of the time? As in, 90% of the time? The mental health benefit requires more cha-ching. (90% was derived from my unscientific, morning cup of coffee to jostle the memory, study).

Usually the most jarring shock is delivered in the form of the mental health deductable. It is not unusual, these days, for me to see $1500 and $2500 before their copay kicks in. Of course, for most, this is a no-getter. No getter therapy. No getter better.

Score one for the insurance industry. They got their premiums. Now you don't get your therapy.

Number of sessions authorized? Going down. It isn't at all unusual, these days, to see "20 visits per year" maximum. Or, lifetime maximum, 60 visits. That's lifetime, people. Which means, if you are diagnosed bipolar you can count on 20 visits per year for three years. Or it might be a dollar amount maximum. $3000 lifetime max. That doesn't cover very much therapy over the adult lifespan, which could be 60 years, easy.

Fees paid to providers? Not going up. Much. Or at all.

A couple days ago my daughter, TwinB, who is at a new school and meeting lots of new friends, approached me, wide eyed. That day she had told a new friend that her mom (me) is a psychologist. "Wow." The girl replied. "You must be rich." TwinB tilted her head at me, as if to say, "What the heck?!?"

This is the same daughter I took to the thrift store earlier in the week to shop for "new" jeans. She looked at me that way because she sees nothing of the rich lifestyle at our house.

We therapy shrinks, the ones paid by health insurance companies, are not making money hand over fist (what does that saying even mean?). Therapy shrinks as opposed to medical shrinks, that is. You know, those real doctors.

But, last I checked the business page, the insurance companies are making it hand over fist. How do we think they have become one of the most powerful lobbies in Washington? Their good looks?

One example. For ten years a certain health insurance company, whose name rhymes with poo-knighted wealth bear, has not increased my fee. Ten years. This lack of regard for inflation means many providers drop off the network. When a poo-knighted client of mine requires psychiatric care, I wince. Good luck finding a quality psychiatry doc who can see you before the next Perseid meteor shower arrives.

Which brings me my next point:

Provider networks are shrinking. No pun intended. I recall when my family doctor posted a sign that they no longer accepted, guess which one? Poo-knighted wealth bear. I knew why. But I asked anyway. The doc, looking none too comfortable discussing his bid-ness with a patient, said he was "having trouble getting payments." I wanted to ask, "Trouble getting a raise, you mean?" But didn't. I had a sick child before him. And I understood his decision. And endorse it even, from the hope that if enough doctors drop off the networks, people will see that insurance companies are dropping the ball.

It's common knowledge that when psychiatrists get a big enough clientele, or patientele, they drop off insurance networks. Private pay only. Those are some pretty discouraging words to hear when you're suffering from major depression because your husband has left you for a younger woman and you have no job because you've been raising his kids for the past twelve years and all you've really got left of your marriage is the fact that he still claims you as his dependent on his health insurance and that will only last until the divorce goes through so you need help now.

And there's more. There's HMO forms and authorization requests and stalled payments and denied payments and being on hold for fricking forever when you call the claims department. But that's about all I have time to go into right now because it's time to head into the office, and you know, be the provider.

But here's my end of the rant summation: The health insurance system, from my view, has tilted into the direction of the wealthy get healthy but the middle class get screwed. And dropped coverage. And depressed. And in need of mental health services but can't afford it.

Ok, after all of that, I'm depressed. I need to make an appointment with a shrink. Oh, but wait. That's right. I can't. I'm self-employed. I don't have mental health coverage. Can't afford it.

So I guess we providers on the networks are shrinking in more ways than one. Or we want to. But we can't afford the coverage.