[Lauliza]

I just got a letter from my mental health care coverage provider (UBH) which informed me that as of July, my pdoc is no longer one of their providers, which must mean he no longer accepts my insurance. They'll cover me for 90 days after termination of coverage which helps. Still I'm pretty upset. I've been a regular patient, seeing him once a month for almost 7 years. Is it selfish to feel a little betrayed? I know he needs to make a living and UBH is notoriously unpopular with mental health providers. I know he has a LOT of patients but he must know who uses which insurance. In a group practice, I thought they all accepted the same insurance, so maybe the group dropped it. Still, like a little kid, I feel like he's leaving me. Of course I can pay out of pocket, but he knows I can't. And I don't want to see someone else. I know I've mentioned my feelings for him on PC, and that's what keeps me motivated to seek treatment. Otherwise I'll drop it. I feel so devastated. Is this normal, can anyone relate?

[Leah123]

I believe that you two have a long term relationship which entitles you to ask for a sliding scale rate so that you can pay what's affordable, such as the co-pay you're used to paying, or perhaps a bit more and continue seeing him. I feel that when we engage with each other in the long term like this, ethics dictate that we see the relationship through, that this type of long-term, intimate work, transcends simple financial considerations.

The way you feel is completely normal. I hope you bring your concerns to him and you two work out a sustainable plan. As it is, you have 5.5 months to work out that plan while you're still covered.

I had to stop seeing a provider before due to arbitrary limitations and it did feel devastating: but I didn't have nearly seven years in with that person. So, I can relate, but hope it ends up better for you, and I think it very likely could.

It sucks when insurance changes, whether via employer, insurance company, or provider. Some insurance companies are a nightmare for providers to work with and they have to make the hard decision to discontinue their contracts. It is a business decision that they know will affect a segment of their patients, but one they make usually after years of hassling and coming out financially behind. It is hard not to take it personally, to think if he really cared about me he would keep taking the insurance. Try to remember you are in a pool of patients when it comes to insurance dealings, and your pdoc can't pick and choose.

Group practices function differently, but in my experience, each doctor has to set his own contracts with various insurance carriers. It really is your insurance carrier failing you here, not your pdoc. I'm sure he would much rather keep his existing patients as long as he could have a good working relationship with their insurance companies.

Bummer! I know you really liked him. I don't know if he would do this but it's worth asking what they would be willing to charge you. My T has told me she would give me a break if i am out of network which is really nice. Doctors are different.

This case in point. I've been looking at policies and asking providers their opinion for this very reason. Is this employer sponsored? Because you could look into other policies in October. My employer pays the absolute bear minimum so there is no reason I have to stick with them. Just an idea.

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[Lauliza]

Thank you all for your support and suggestions. It does help me keep this in perspective. I will have to explore what options I have. I highly doubt he'd take just my co pay as payment, though a sliding scale fee would seem fair. I'm unfortunately not in a position to change insurance. It is a family plan under my husbands corporate policy. It is actually one of the best in the country for patients even in mental health. It's the providers that they are terrible for. Doctor reimbursement is very low.

[stopdog]

Is it possible there is an out of network reimbursement rate? Your part might be bigger, but the insurance company pays something.

[sunrise]

Originally Posted by stopdog

Is it possible there is an out of network reimbursement rate? Your part might be bigger, but the insurance company pays something.

Ditto on this. For example, a preferred provider may be covered at 90% and an out of network provider at 60%, which might make it possible for you to continue seeing your pdoc. Check with your insurer on their out of network reimbursement rate. Good luck, hope you can make it work.

[Lauliza]

Originally Posted by stopdog

Is it possible there is an out of network reimbursement rate? Your part might be bigger, but the insurance company pays something.

Thank you for suggesting this. The letter UBH sent me did not mention anything about in or out of network. I will definitely ask about this though on Monday when I call.

[msxyz]

Do they offer any out of network coverage at all?

[Lauliza]

Originally Posted by Akama

Do they offer any out of network coverage at all?

My guess is they don't since there is no mention of it. Ice seen HMOs and other plans offer out of network coverage, but I've never seen anything about it mentioned in the literature or online. Their are has a function where you can search for doctors/Ts. If they aren't there, they usually don't take this insurance.

[Perna]

I would talk to him/his staff and see what accommodations can be made and talk to your insurance, see if they will still pay (that your doctor does not deal with the insurance company anymore does not mean that your insurance will not deal with the doctor! You may just have to do the paperwork yourself is all). I think you have to talk to him. I do not think he knows off the top of his head that "you" have that insurance and, as you point out, the practice may have quit taking it, not him, personally. Doctors' are notoriously unfamiliar with insurance issues, they have staff that are in charge of that, they have to work hard at keeping up with being a doctor.

Originally Posted by Lauliza

My guess is they don't since there is no mention of it. Ice seen HMOs and other plans offer out of network coverage, but I've never seen anything about it mentioned in the literature or online. Their are has a function where you can search for doctors/Ts. If they aren't there, they usually don't take this insurance.

Out of network means you have to pay for it and submit it yourself. Maybe they exist but I have never seen a PPO plan not have an OoN provision. HMO is a different story. If I were to go with Kaiser (which I won't) I would pay for all my MH care including meds on my own because I think the MH dept in my area is horrible. I would not even be able to fill my prescriptions at their facility. That, of course, makes it cost ineffective.

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[msxyz]

Originally Posted by Lauliza

My guess is they don't since there is no mention of it. Ice seen HMOs and other plans offer out of network coverage, but I've never seen anything about it mentioned in the literature or online. Their are has a function where you can search for doctors/Ts. If they aren't there, they usually don't take this insurance.

Often insurances will reimburse out of network providers at a lower rate, I would ask about that.

[Lauliza]

Originally Posted by Perna

I would talk to him/his staff and see what accommodations can be made and talk to your insurance, see if they will still pay (that your doctor does not deal with the insurance company anymore does not mean that your insurance will not deal with the doctor! You may just have to do the paperwork yourself is all). I think you have to talk to him. I do not think he knows off the top of his head that "you" have that insurance and, as you point out, the practice may have quit taking it, not him, personally. Doctors' are notoriously unfamiliar with insurance issues, they have staff that are in charge of that, they have to work hard at keeping up with being a doctor.

They do have a completely separate billing department and he does not talk about money issues with me, ever. If you have a balance it is this woman who invoices you and it represents the practice, not him personally. So I doubt it is a conversation he will want to have with me. But, I think it's only fair if their ends up not being anything my insurance company is willing to do regarding coverage as out of network. I don't want to be that problem patient, but I won't go see someone else either.

[Lauliza]

I do have a positive update on this topic...

I spoke to my doctor's office and he had no idea what this was all about. According to UBH's customer service person, he was the only doctor in this practice no longer contracted with them. But according to my doctor's office, he did not drop or change his contract with them. So, it's an error on the insurance company's end. Thank goodness!

[Mike_J]

I got the same letter last year.

My insurance has an out of network co-pay once that is met they will pay my therapist what they feel is a "fair market price" amount regardless of what they are billed. But that amount is way more than they were paying my therapist when she was "in network"

I worked out an arrangement with my therapist that is fair for both of us