‘In-Network’ vs. ‘Non-Participating’: a Big Deal?

Unfortunately, in today’s economy one of the first factors used to choose a physician is whether or not the person is ‘in network’.  While there are times when such a determination should guide one’s search, I would suggest that for several reasons, your choice of psychiatrists should take place without limiting your search to the small group of in-network doctors.  I will explain my reasoning in a moment, but first I would like to describe the nature of my practice.

When you are seen in my practice, I will submit your claim to your insurer for you and do all that I can to maximize payment of your claim by your insurer.  I will then bill you for any remaining amount not paid by the insurer.  There are a couple cases where your portion of the bill will be very small.  First, I participate in a nation-wide group of otherwise independent physicians called ‘Multiplan’.  The Multiplan network is used by many insurers to provide additional choices for their member patients.  How do you know if your insurer uses Multiplan?  Look at your insurance card for a small ‘M’, or for the word ‘Multiplan’.  The network is also called ‘Health Eos’, and sometimes that term is written on the card.  If your card says ‘Multiplan’, you are likely covered for at least 90% of all charges– meaning that your out-of-pocket payments are minimal in my practice!

There are a few other insurers that I have partnered with over the past few months.  Specifically, I now have a relationship with Network health and United Healthcare that allows me to see their patients for minimal out-of-pocket costs.  If you are not certain whether I am ‘in network’, please call my office and ask!

I have always said, though, that I will only join the networks that place no or minimal restrictions on my ability to practice good psychiatry.  I have NO interest in being listed in a provider list if in return I am expected to practice a certain way.  Many health ’systems’ are members of every single network, but they offer a type of psychiatry that I find to be downright silly–  where patients have 7 minutes of time with the psychiatrist to discuss how they are feeling, to discuss any medication side effects, and to somehow feel ‘supported.’ I am committed to seeing every patient for 20-30 minutes– at a minimum.  And so the insurers that offer ‘low-ball’ contracts that the big systems make up for on volume are not panels that I want to join.  I will, though, do all that I can to maximize payment on your claim.

There are dangers to limiting your options to ‘in network’ psychiatrists. In a town like Fond du Lac, all of the participating psychiatrists for most of the insurers belong to the same medical group. At first blush your book contains six or eight psychiatrists… but then you find that they all practice within 50 feet of each other, and are all subject to the same policies and practice patterns. Some choice! As an independent psychiatrist I answer to nobody except you, the patient. I teach at the Medical College of Wisconsin in Milwaukee in part because I love teaching, but also so that I remain in contact with the people who are at the front line of psychiatric research and development.

There are many factors that determine the amount of coverage under your insurance policy besides whether the doctor is ‘in network’. Many plans have insurance plans with deductibles; a person with a $1000 deductible may not cover the deductible in any one year, and so whether or not the psychiatrist is ‘in network’ is a moot point. After my first visit with a new patient I encourage a discussion of the options available, the person’s interest in type of treatment (medication, therapy, or both) and the desired frequency of follow-up after balancing cost and care issues. There is no value in a prescription for a great medication if you do not have the money or coverage to take it!

One final issue that relates to the choice of psychiatrist is that more than in other areas of medicine, you will want a ‘good match’ with your psychiatrist. In order for treatment to have the best opportunity for success, you will want to feel at ease discussing ALL aspects of your life and lifestyle with your psychiatrist.

I work hard to provide the best psychiatric services possible. I want patients to have the time to remember all of the things that were on their minds since the last visit. As I often say, I don’t want you to see a psychiatrist; I want you to have a psychiatrist.