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New Study Finds Psychiatrists are Less Likely to Accept Health Insurance

Psychiatrists and health insurance

The Affordable Care Act Will Affect Coverage but Not Necessarily Service

A recent study found that fewer psychiatrists are accepting health insurance. The study, published by the JAMA Network, was conducted over the course of three year groupings, 2005-2006, 2007-2008 & 2009-2010.

The results were shocking. An incredible 55% of psychiatrists do not accept private insurance, as opposed to 89% of other doctors. Additionally, Medicare and Medicaid coverage accepted at a lower rate by psychiatrists, 55% and 43%, compared to 86% and 73% respectively.

A continued push for mental health opportunities means this reduction in coverage puts an even larger strain on emergency mental health care providers. The new healthcare law has however included mental health in its list of 10 “essential health benefits” that must be covered by insurers. Additionally, discriminatory policies that allow insurers to charge a higher copay or deductible or to set caps on mental health services will no longer be allowed under the new law.

Unfortunately, this does not necessarily solve the problem. Even though an individual may be insured & mental health services covered, this does not mean there will be a mental health professional, like a psychiatrist, in their area that accepts the insurance they carry. This is a hurdle not yet addressed by the Affordable Care Act. Not surprisingly, the demand for psychiatric services is high & these doctors have plenty of patients to keep their practice running. Due to generally more involved treatments and long term treatments, psychiatrists can opt not to accept insurance and instead accept payments out of pocket.

There are quite a few reasons there is such a large difference between accepted coverage by psychiatrists or other healthcare professionals. This includes low payments to providers as well as privacy concerns as reviews are done by managed care companies.

So, what does this mean for people in need of psychiatric or other mental health care? Many psychiatrists simply charge what they can for services and implement a sliding scale.

Want to learn more about this study? You can find information and analysis at the JAMA Network site: http://archpsyc.jamanetwork.com/article.aspx?articleid=1785174#Discussion & at the New York Times: http://www.nytimes.com/2013/12/12/us/politics/psychiatrists-less-likely-to-accept-insurance-study-finds.html?_r=0

Are you in need of insurance billing assistance? Billing Advantage can help with all of your billing needs.


Richard Kaufman Richard Kaufman

Richard Kaufman LICSW has performed and overseen medical billing activities for over 30 years. Being a mental health provider himself, he has particular expertise in mental health billing. Rick is an experienced computer programmer and is an expert in medical billing software and EHR software and the interface between these. He has served as a consultant to billing software companies and continues to improve upon existing billing platforms with his programing expertise. As co-owner of Billing Advantage Inc., Rick is involved in all aspects of the company but his particular contributions to the business are in pricing and overseeing of employee productivity and AR.


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