12/04/2018
After a 2 year experiment on accepting commercial health insurance, we have come to the decision to terminate our contracts with the following insurance plans, effective February 1, 2019: Blue Cross/Blue Shield (BCBS), Cigna, Magellan, ComPsych, & United Healthcare/United Behavioral Health (UHC/UBH).
There's a reason so few psychologists accept insurance. The fact is that insurance reimbursements are built on the premise of quantity over quality. In order to make the practice financially viable under commercial insurance we'd have to see 5-times as many patients. Considering that Dr. Larery spends, on average, 8 hours on every single patient she sees this prospect would result several things; abbreviated reports, rushed appointments, reduced face-to-face time with Dr. Larery, and (likely) a miserable Dr. Larery and unhappy patients. She loves her patients, and she loves that she gets to help them through these difficult situations. She loves that she has the flexibility to turn a 45 minute appointment into a 2 hour appointment to help a patient or their parents understand the diagnosis she's given. That can't happen as an in-network provider.
Added to that is simply an overall frustration with the insurance companies in general. For example, three weeks ago we got a referral from a neurologist to perform an evaluation on a boy following a traumatic brain injury. We sent in the pre-authorization form to BCBS, as is our policy. We then performed the evaluation and submitted to the insurance company for reimbursement. They denied the claim because, unbeknownst to us, the neurologist forgot to inform the insurance company of the referral *before* we performed the evaluation. We faxed over the referral the neurologist sent us, but they still denied our claim because they said they didn't have the referral from the neurologist in their system *before* we performed the evaluation. We got paid $0 for a comprehensive 10-hour evaluation. And this has happened again, and again, and again. On several occasions an insurance rep will tell us "yes, Patient A is covered and we will reimburse for their evaluation" only to have the claim denied and another insurance rep to tell us, "oops, the previous rep was wrong, they shouldn't have told you the patient had coverage, so we're not paying for it. LOL, sucks to be you."
With that said, say what you will about 'government healthcare,' all I have to say is that Medicare and Tricare, in contrast, are joys to work with. They reimburse well, and they reimburse quickly and with no drama. As a result we're staying in-network with them. Commercial insurance, however, has been a long nightmarish experience and we've had enough.
We realize this will mean many of our patients may not be able to afford our services, and that pains us. We firmly believe that a comprehensive diagnostic evaluation can be the foundation of important mental-health decisions. We will always work with our patients to find the most cost-effective way to receive the services they need, including providing reduced-price services for those with demonstrated financial need.
Thanks everyone and we appreciate your continued support during this transition.
David
