Why do so many psychiatric providers not accept insurance?

That is a great question and one that really reflects the problem with health insurance and our mental health system.

Health insurance companies collect premiums or monthly payments from patients/subscribers to pay claims (bills for medical services provided). The problem is that for providers, they (insurance companies) often do not pay claims or invoices for services billed for patient care (to us).

I personally have found that, too often, claims are denied for administrative reasons such as failure to add a code for something that is often not necessary, error codes like wrong zip code (if the four digit number after the main zip is not added and we don't know they require it), insured not found (this one is my favorite) even if you actually do have insurance with them, and other seemingly small issues.

Each time an error is claimed, by insurance, whether correct or not; the payment is delayed at least 30 days if not more. Each time they claim an error they get to keep the money you paid them and money they owe us. In the meantime we have to find a way to pay our employees, rent, utilities, malpractice insurance, licensing fees, taxes, city fees, state fees, monthly software costs, email, phone, our own salary, etc.

I once had an insurance company (they who shall not be named) employ these tactics for one year, which delayed payment to my practice, for services already rendered. I have also had another insurance company (yup, another who shall not be named) sign a contract to provide coverage for patients under their insurance, as a special arrangement because I was not a contracted provider with them (I did not accept this insurance), then still NOT pay! I had no choice but to then bill the patients knowing I would likely never be paid the thousands owed to me for services already rendered. The latter meant my paycheck that pay period was very, very low-I made more in 1997 as a Secretary than that paycheck.

So imagine, working for your boss, then not receiving a paycheck because you didn't include a code, you were never required to add before or did not know you needed to add; then repeat that several times. How long would you wait to get paid before quitting that job? If it were me, probably not long because bills at home must be paid and we all need to eat at some point.

This is why many psychiatric providers do not accept insurance because they can't afford to.

I have been told, by seasoned medical billers, that they had never experienced the unnecessary delays in payment seen in psychiatry in any other specialties. Sad, but true.

In addition, psychiatry has one of the highest administrative loads of all specialties. What does that mean? Anytime we need to fight with insurance, fill out prior authorizations for medications you need, call pharmacies to discuss delays or errors; call to answer a question outside of appointments, etc - this is an administrative task. In addition, the history we need to collect prior to your first appointment and the documentation (notes) we need to complete after each visit, just to get paid is far more extensive than most other specialties. All of those administrative tasks go unpaid most of the time.

Lastly, most insurance companies reimburse or pay us at primary care rates even though we are a specialty.

Everything seems stacked against us and our patients. I know what you are probably thinking, the system is broken! Trust me, we agree but we keep fighting it along with you because we believe mental health is so important!