Therapist no longer taking insurance

Where is the leadership in Mass. compensation debate? | New England Psychologist

This is just not happening in Massachusetts it is happening where I live as well and I am seeing it first hand with my therapist. Once he got a foot hold in the area, as he started his practice last year, he raised his rates to $200 and stopped taking insurance. This leaves people who can not afford an extra $800 a month for therapy out. Trying to find a good therapist taking insurance is getting harder. I pay a $30 copay and then he gets $75 from the health insurance. Try getting a good massage for less than that. I charge $120 for a massage and places like Red Door charge over $200. Therapist go through a ton of education, internship and the supervision but do not get paid what they are worth. So when we are looking to get between session contact through phone calls or emails I always do think about the cost of his time he gives up for me.

I understand. All of the therapist are leaving my area.

Some therapists/pdocs will/do accept/negotiate cash prices, which are lower than the rates paid by insurance, as the cash payment arrangement involves no insurance and no claims. Circumventing the use of insurance can potentially save a practitioner a lot of money, as many hire out the accounting part of their practice. There are many practitioners in my area who have switched to this cash only model.

I hope you can find a practitioner within your budget.

I worked for Doctors my whole life. Front office , back office and billing.

When HMO’s became a thing it looked like on paper a good idea for Doctors to sign up, but in the early days Doctors had signed a contract and then the HMO really dictated what test, referrals to specialist and medications given. And some Doctors did get a kick back for saving the HMO’s money. That did hit the fan legally and morally and a lot of that stopped.

HMO’s at the time we’re very appealing to people because in general it was cheaper than standard insurance.

Early 90’s one of the Doctors I worked for did not renew contract for any HMO’s he was sick of the low reimbursement. He lost half his patients, but soon enough his practice was filling up and he was making a good living and didn’t have to work 14 hour days anymore.

Back in the day Medicare was considered top notch great insurance a Doctor could order tests and referrals to specialist at will.

Medicare started reducing reimbursements a little at a time, at first it was like “ well okay” as far as billing and receiving payments Medicare was the quickest.

By 93-94 I believe , Medicare was still dropping reimbursement. My father’s Doctor quit accepting it, he set a very low office visit cash, which was honestly a bit lower than what Medicare would have paid. He could refer to any specialist as they would accept Medicare

I was doing billing for a Doctor late 90’s he also decided to stop accepting Medicare , he accepted PPO plans and other straight insurance plans because they paid a decent amount.

People think Doctors make millions a year .. no they don’t , maybe top notch specialist doing tricky surgeries but your general GP’s not so much, most are saddled with enormous school loans.

I recently saw a Pulmonary specialist. His new patient OV was 225.00 billed to Medicare. Medicare approved at 98.00 and I will pay the 20%

Basically a Dr could charge 500.00 for a office visit but Medicare will still only approve X dollars..

My GP accepts Medicare but to make his billing easier ( he’s a rural small town Doctor ) he has a flat fee of 20.00 per visit which is cheaper than Medicare would expect me to pay.

Medical insurance is a mess and hopefully things will improve.

Great info. Interesting!
It is all a big mess now.

I hope there is a way to get everyone what they need.

My psychiatrist stopped taking any insurance in 2008. He is in high demand and a smart businessman and here where HMOs sort of got their start, he saw the writing on the wall early on. He now charges $350 an hour, so I book a 30-minute visit, which is all I can afford, and I only go when I have to. I cannot afford a therapist and him, which is a shame, but I have other people I support and it's just not in the cards.

My practice was largely a cash business, maybe 70/30 cash vs. insurance. I always accepted whatever the insurers paid, including medicare. I felt it was my duty, bu lots of docs don't share that view. Getting paid 25 bucks for an office visit won't really keep the doors open.

Great points!
Sometimes, we forget the doctors also have hefty student loans to repay.

I live near a teaching hospital. Some of the area pdocs have been trying to recruit young doctors as they finish med school, as we are very short on pdocs here. The young doctors refuse to do direct patient care, citing the inadequate income and the inability to repay all of their loans if they do not take administrative positions.

I wonder what this will all look like even just 3 years from now?

Love to All!

What will happen is we will lose choice. The average age of a psychiatrist is in the 50s. There are fewer medical students choosing psychiatry as a field. That is a disaster waiting to happen. The demand for psychiatric care is skyrocketing and the supply of physicians is dwindling. Inpatient psychiatrists are hit hardest. They do the most demanding, complex, and sometimes dangerous work. Fewer new psychiatrists want that kind of burden on top of medical school debt. PAs and NPs are being used to fill the gap, but for serious illnesses they really aren't competent.

If you have a psychiatrist and you have a good relationship with him or her, you will be in the minority is just a few years.

Thanks for sharing your knowledge!

I believe you are right on with the ages of pdocs and the readiness to retire soon. My pdoc of 20 years has retired a year ago. The ONE pdoc willing to take me as a patient (as a favor to my pdoc) is 64 y.o. and it won't be long before she retires.. So may around here are retiring very soon or in the near future.

I do not know what everyone is going to do for care.

I also believe that many of us need "experienced" pdocs. I think we will be getting young, in experienced pdocs and/or inexperienced PA, NPs.

Beggars cannot be choosers?
Will we all be beggars soon, as in begging for appropriate care?

I am very concerned. (I am not "worrying" about it, however. At least not yet.)

Love to All!

I think a lot of patients are in denial about what's happening with psychiatrists. They seem to think psychiatrists are as plentiful as therapists. There is an endless supply of therapists. There is a limited supply of psychiatrists. I write a lot about the psychiatrist-patient relationship. What patients need to learn is how to have a good relationship with a physician who may not be Dr. Perfect. The day of being able to Dr. hop is fast coming to an end.