Can Patients Find a Psychiatrist Covered By Their Health Plan?

Leslie Citrome, MD, MPH


December 27, 2013

Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care

Bishop TF, Press MJ, Keyhani S, Pincus HA
JAMA Psychiatry. 2013 Dec 11. [Epub ahead of print]

Study Summary

Bishop and colleagues describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties using data from a national survey of office-based physicians in the United States. The percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% vs 88.7%) and had declined by 17% since 2005-2006. Similarly, the percentage of psychiatrists who accepted Medicare in 2009-2010 was significantly lower than that for other physicians (54.8% vs 86.1%) and had declined by 19.5% since 2005-2006.

Psychiatrists' Medicaid acceptance rates in 2009-2010 were also lower than those for other physicians (43.1% vs 73.0%) but had not declined significantly from 2005-2006. Psychiatrists in the Midwest were more likely to accept private noncapitated insurance (85.1%) than those in the Northeast (48.5%), South (43.0%), or West (57.8%).


The investigators proffer several possible reasons for the low rates of acceptance of insurance by psychiatrists compared with their nonpsychiatrist colleagues. These include lower reimbursement than desired given the amount of time required to deliver the necessary services. Lack of competition because of a shortage of psychiatrists is another potential reason – many psychiatrists in some regions of the United States have so much demand for their services that they do not need to accept insurance.

The investigators also found that most office-based psychiatrists have solo practices and that solo practice was independently associated with nonacceptance of insurance. This makes sense: Many solo psychiatric practices have little need for the infrastructure that is often required by clinicians in other disciplines or in larger single-specialty or multispecialty group practices.

Unfortunately, the low rates of acceptance of insurance may impede access to care for many persons. "Out-of-network benefits" often cover only a portion of the bill at the usual and customary rate; even for some of the better plans, 20% of a $500 fee remains a substantial burden, especially when combined with copays for medications that can be as high as $90 (or more).

Not mentioned in the report are the actual fees charged by individual practitioners. In wealthier urban areas, rates can be substantial (eg, much higher than my own), entirely unrelated to the experience of the provider, and sometimes accompanied by anachronistic demands that the person be seen weekly and be responsible for payment of his or her weekly "slot" indefinitely and without consideration of clinical need. These and other anecdotes about access are not uncommonly reported to me when I am asked by patients who are moving to a new city to help them find a "good psychiatrist."


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