After being in the field of psychiatry for nearly three decades, I recently
decided to change how I am paid for my services. Six months ago I informed my
patients that at the beginning of this year, I would terminate my
participation in all third-party payment plans, including Medicare. I
explained to them that I wanted to practice without the constraints imposed by
insurers and experience the sense of freedom that would result.
Some of my patients accepted this, and others expressed their discontent.
For those who wanted to stay in my practice, I offered the option of
submitting my receipt to their insurer for possible reimbursment or paying me
on a sliding-scale basis. More than half of my patients chose to transfer to
other psychiatrists whom I had recommended.
Now I have a lighter caseload and am able to see patients with fewer time
constraints. An answering machine plays a message about my practice and tells
callers how to reach me by pager if necessary; it also records messages for
later playback. I have found that patients like the feeling that I have more
time for them and that their records have greater confidentiality since no
information is transmitted to their insurers.
From the bookkeeping point of view, I no longer have to worry about staying
up to date on tax guidelines regarding quarterly filings and maintaining
current insurance information on multiple companies for the secretary, who was
spending most of her time on the phone with insurers.
A few years ago I was warned by a managed care agency that my documentation
did not meet its guidelines. The documentation had been reviewed by a social
worker contracted by the agency, and he had gone into areas apparently outside
his field of expertise. I was given a chance to improve my documentation along
with a recommendation to enroll in an educational activity! Another agency
asked me to file my curriculum vitae on the Internet and update it every three
months to maintain my credentials. With such treatment by insurance companies,
you cannot imagine the glee I felt when I advised them that I was withdrawing
from their plans.
Time will tell how my professional future will go, but one thing is
certain—I will never go back to being an employee of managed care.