Offices in Castro Valley & Pleasanton, CA
June 27th, 2016 | Behavioral Consulting, Cognitive Therapy, Stress, Uncategorized

Solutions to Health Insurance Woes

This post offers some solutions – short-term and long – to the problem identified in my last post: trying to find a therapist or doctor who will accept your health insurance for mental healthcare.


Long term, the only reasonable fix to our broken healthcare system is to get private insurance companies out of the business of being gatekeepers for our healthcare, because their business model – collect as much as possible in premiums, while paying out as little as possible when members actually try to use their “benefits” – is completely at odds with what the goals of a sane and humane healthcare system ought to be.


We also need to get employers out of the business of providing healthcare benefits. That system was set up in another era, when the economy was stable, people stayed with the same company until they retired, and medical care was more affordable. The current costs of providing employee healthcare benefits are enormous, so employers constantly look for ways to cut them, which include changing plans annually (causing headaches for employees who must then switch doctors) and hiring third-party-administrators to restrict access and deny treatment.


Who, then, should perform the gatekeeper function, administer and pay for our basic healthcare benefits? Before you say, “oh no, not the government!” consider Medicare: not a perfect system, but since 1965 they’ve administered healthcare for a significant segment of our society, and for the most part, they do it effectively – and cost-effectively. Their overhead averages around 2 percent, vs. the 12 to 20% profit rate of the private insurers.


Medicare is one of the few insurance panels I’m still on, and while they don’t pay me any more than Blue Cross or Blue Shield do, I’m OK with that, because I know their adminstrators are not getting rich off of my hard work. And my patients who are on Medicare are usually happy with their plan and benefits, once they get used to the system. In fact, I can hardly wait until a few patients in their early 60’s will turn 65, so they’ll be able to get more affordable mental healthcare.


Consider also our public school system. We regard it as our right to have free K-12 education for all Americans (and affordable options for college). Isn’t healthcare just as important as education? Why not model our healthcare system along the lines of our educational system, with a basic and free system for all, supplemented by private options for those who can afford them?


A universal or single-payer healthcare system exists in most other first-world countries, and it’s totally feasible to implement in the U.S. There’s a reason Senator Bernie Sanders is promoting a “Medicare-for-all” system – because most Americans recognize the value of the Medicare program. Last month the nonprofit Physicians for a National Health Program released “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform,” which provides a blueprint for implementing a nonprofit national health program, and proves that it can be done affordably.


But what can you do, today, to get the mental health services you need now? One option is to get assertive with your health insurance plan: make them find a provider for you. Let them know if you’ve called all of the providers on their list, without success. Expect them to give you the runaround, and be persistent – you’re paying them! Don’t get stuck on this as your only option, though. You could be better off looking outside of your health plan for the right therapist for you.


Per the KQED Forum report referenced in our last post, the “typical” Bay Area psychotherapist in private practice charges around $200 per session. However, I know plenty of therapists who charge around half that amount, and there really is quite a range – depending on factors like location, how many years the therapist has been in practice, and what degree(s) and specialties they have. So it pays to shop around. There are a number of online therapist directories to search, Psychology Today being the largest, including GoodTherapy, HelpPro, and TherapyTribes.


Many therapists, myself included, offer reduced fees for students, seniors, the unemployed, or people going through a divorce or other financial difficulties. Others will negotiate their fee on a case-by-case basis. It always pays to ask! And check also to see if your health plan offers partial reimbursement for providers outside the network. Most therapists in private practice will be glad to give you a statement to submit for reimbursement, though you’ll need to pay up front.


Other options to consider: 1) reduce the frequency of visits – you may get as much benefit from seeing an out-of-network specialist once a month, as weekly visits to a plan therapist; 2) try group therapy – the typical fee is around $40-50 per session; or 3) see an intern – someone who has completed their clinical education and training, and is accumulating the 3,000-plus hours of supervised clinical work that is required to get their license. (Not all interns are in their 20’s – some are becoming therapists as a second career, and have valuable life experience.)


So if you’re seeking mental healthcare, don’t despair! Be patient, persistent, and support single-payer!

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