I am frequently asked “what health insurance plans do you accept?” and I know that many people may immediately draw incorrect conclusions from my response. The answer is that I don’t participate with any health insurance plans. Many times this reply may cause an initial negative reaction in folks. People think things like “well, that’s not helpful” or “oh, she only cares about people who have money” or “I guess I won’t be able to see her since I have insurance and am not rich.”
As it turns out, none of those things are true! Please let me explain.
First, some background about me. I did not decide to pursue becoming a doctor due to dreams of wanting to become rich or famous. Quite the opposite, in fact, I quit a decent paying job and took out enormous student loans in order to pursue my dream of becoming a physician to help people in need. When I first entered medical school, I already knew that I wanted to work with underserved patients. In additon, I have always had a passion for helping those who are less fortunate, and I thought medical school would help me finally fulfill my dream.
Fast forward through four years of rigorous medical school, one year of grueling medical internship, three years of intense psychiatric residency, one year of a very busy dual fellowship in public and emergency psychiatry, and almost three years of working as an attending psychiatrist and assistant director in an extremely busy urban emergency room, and here I am now. After all this time working in the US healthcare system, I slowly began to realize that I was not helping my patients like I really desired to do. And worse yet, I felt that no matter how hard that I tried, many of my patients only became more sick.
With all my training and experience as a physician, I felt pretty confident that I knew how to help many of my patients. However, I found it more and more challenging to do my job well. And there is one glaring reason why, which has become more and more apparent: the healthcare system in the United States is broken. It fails the patients, it fails the doctors, and it fails itself. The United States spends more than any other country on this planet on healthcare, yet still has many very ill people and poor health outcomes. There are multiple causes driving this issue, but one of the biggest is the existence of health insurance companies. Let’s look at some of the problems.
5 big problems with health insurance companies:
- Health insurance is super expensive. Health insurance in the US is being used to pay for every single type of minor medical issue and hence insurance premiums are now astronomical. When you buy car insurance you don’t expect that it will cover an oil change or check-up. You expect it to cover you for big expenses like car accidents. And the result is that car insurance is (usually) fairly affordable. Because we use health insurance to pay for expenses related to minor illnesses and basic check-ups, the rates continue to go up and up! If instead of paying ridiculously high health insurance premiums, we paid reasonable fees for high-quality care, the United States would be a healthier place.
- Insurance companies do not pay doctors very well. This means that in order to avoid going out of business, many doctors need to see more and more patients in shorter and shorter periods of time. They are forced to over-schedule appointments, leading to very long wait times for patients. All of this leads to overworked, stressed out and unhappy doctors. And overworked, unhappy doctors leads to poor care and unhappy, unhealthy patients!
- Health insurance companies dictate patient care. This is one of my biggest pet peeves! If a psychiatrist, such as myself, were to contract with a health insurance company, this creates a relationship whereby I am basically working for the company. This means that they can (and frequently do!) pressure me to prescribe medications for a patient who may not need it. They also can refuse to pay me for performing certain services, which I (being the expert and the one who actually knows the patient) feel the patient needs. And many times they limit the frequency, duration and type of treatments that I can provide, which again leads to less than optimal care and unhappy, unhealthy patients!
- Doctors prescribe too many medications. Due to the time and financial constraints caused by insurance companies, doctors end up relying heavily on medications to treat their patients. This one is super important! If I am seeing 50 patients a day, each for 5-10 minutes, I do not have the time to ask them about their diet, how they are getting along at home, or how they are even going to pay for the prescriptions I write. I have just enough time to write a prescription for them and rush them out of my office (which the insurance company prefers). While medications can definitely be an important type of treatment, it is but one tool in our arsenal, and it frequently comes with many associated side effects. Using medications alone for treatment does not lead to happy or healthy patients!
- Health insurance companies are nosey. This is especially relevant when it comes to mental health care. If a doctor participates with health insurance companies, this means that they are required to release sensitive patient mental health information to them. Many folks do not necessarily want all of their confidential mental health information to be publicly available, but this is what the system mandates. Once the health insurance company knows the details about a patient’s diagnosis and treatment, they can start meddling in ways that once again bring us back to poor patient care!
Given all of the above issues with the world of health insurance, I made the deliberate decision to not participate with any health insurance plans. It was a difficult decision for me to make, but I made it out of a strong desire to do what is right and to be able to provide high-quality, individualized care to all of my patients. After all, I made the long journey through medical and psychiatric training for one reason, and one reason only, and that is to actually help my patients. If I’m not helping anyone, then why did I become a doctor in the first place?
On anther note, you might wonder, “well, if you don’t participate with health insurance plans, how can patients afford to see you for treatment? Well, fear not, they absolutely can, and I will be addressing that in a separate post. Also, if you have health insurance, you can still use it to pay for our fees. You can find out how here.
I am constantly looking for feedback and ways to improve my practice so that it is better for YOU! My email inbox is always open, so please feel free to let me know your thoughts: [email protected].
NOTE: While there are many issues with health insurance, I am NOT recommending that people go without coverage. It remains necessary given the current world of healthcare. I personally have health insurance and I do recommend that all people have at minimum “catastrophic” coverage.
[…] for providing a valuable service. I covered this topic in more detail in a recent blog post, “Why We Don’t Participate with Health Insurance Plans.” However, when you stop and think about it, doesn’t it make sense to spend money on […]
Does this mean you could/would write a Rx for bio-identical hormones?
Thanks for your question. While I hypothetically can write prescriptions for bio-identical hormones, I find that I rarely need to. Hormone therapy is not completely benign, so I usually start with interventions that work extremely well, but with very little potential side effects or dangers. If you have more questions, feel free to schedule a free 15-minute phone consultation and I could tell you more about what I offer!