The Great Insurance Debate

January 28, 2010

Many child psychiatrists do not take insurance. At BACA, as a non-profit agency, we have a mission to provide access to care to all individuals who need help. As such, we are working to accept all insurance plans. Unfortunately, there are many struggles associated with accepting insurance (which is the reason why so many mental health providers do not). To begin, we try to integrate care at our agency – this means that we provide both therapy and pharmacotherapy (prescribing medications) services at our agency. Mental health care is extremely fragmented in our society, which leads to worse outcomes and more difficulties for families. We hope to provide all services relevant for improving mental health functioning (psychotherapy, biological treatments including medications and exercise, occupational therapy, speech therapy and even tutoring!) at our agency one day. The problem, is that many services are not reimbursed at reasonable rates – especially for physicians who wish to deliver therapy services. Several insurance agencies will negotiate reasonable reimbursement rates, but others are less willing. In addition, although electronic billing and other technology has made reimbursement easier, there are continual “errors” by insurance companies that require administrative time to remedy, thus driving up costs. Currently, for out-of-network clients, we give a “superbill” which can be submitted for reimbursement. I am thinking about changing this, so that we actually will submit all billing (whether you are in-network or not) which would make it easier for our families, but more difficult for us. The best thing to do is complain to your insurance company if you have limited mental health treatment options. We sincerely wish to take every insurance available, and now do accept Medi-cal. I am hoping that the new law passed in California regarding being seen in reasonable time if you are an HMO member will help us to negotiate fair contracts.

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