Magazine article Clinical Psychiatry News

Psychiatrists' Rates of Insurance Acceptance Falling: From JAMA Psychiatry

Magazine article Clinical Psychiatry News

Psychiatrists' Rates of Insurance Acceptance Falling: From JAMA Psychiatry

Article excerpt

Psychiatrists are markedly less likely than are office-based physicians in other specialties to accept insurance, a report published online recently in JAMA Psychiatry showed.

Moreover, psychiatrists' rates of insurance acceptance are plummeting over time, compared with those of other physicians. In 2009-2010, almost half of all psychiatrists in the United States did not accept private noncapitated insurance, and more than half did not accept Medicare or Medicaid, said Dr. Tara F. Bishop of the departments of public health and medicine, Cornell University, New York, and her associates.

This can adversely affect access to mental health services for patients who are unable to pay for psychiatric care out of their own pockets.

"To our knowledge, no prior studies have documented such a striking difference in insurance acceptance rates between psychiatrists and physicians in other specialties. These low rates of acceptance may affect recent calls for increased access to mental health services, and if the trend of declining acceptance rates continues then the impact may be even more significant," the investigators noted.

In an interview, Dr. Rodrigo A. Mu[n]oz said psychiatrists have many reasons to distrust and avoid insurers. "This is very true in Southern California, which has been characterized See Insurance page 31 by poor insurance coverage; HMOs with severe limitations for psychiatry; multiple, invasive, and unfair rules; and in the case of companies like UnitedHealth, ridiculous auditing conditions that make a mockery of the process," said Dr. Mu[n]oz, professor of psychiatry at the University of California, San Diego.

Dr. Lee H. Beecher, who shifted to a cash-only practice several years ago, said he was not at all surprised by the findings.

Psychiatrists in large numbers are opting out of third-party insurance for two basic reasons rooted in dinical-scientific rationales and economics, Dr. Beecher, professor of psychiatry at the University of Minnesota, Minneapolis, said in an interview. The clinical-scientific rationales are that allowable payment rates for outpatient psychiatric services fail to "support the provision of quality patient-centered evidence-based psychiatric care to patients and their families. Also, "Medicare, Medicaid, and private insurance payments are much too often insufficient to cover the costs of maintaining a quality office-based psychiatric practice."

In the study, Dr. Bishop and colleagues examined the issue using data from the National Ambulatory Medical Care Survey (NAMCS), a physician survey administered by the Centers for Disease Control and Prevention's National Center for Health Statistics. …

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