One of the questions I am frequently asked by prospective patients is why I don't accept health insurance.
It's a reasonable question. Health insurance is expensive, and patients understandably expect to be able to use the benefits they pay for. My decision to practice outside insurance networks is not one I take lightly.
There are several reasons for this decision, but they all come back to a simple principle: I believe decisions about psychiatric treatment should be made by the patient and physician, with as little outside interference as possible.
Clinical Independence
Psychiatry is not always straightforward. Diagnoses can be complicated, treatments sometimes require considerable adjustment, and patients do not always fit neatly into diagnostic categories or standardized treatment protocols.
Insurance companies, however, operate according to policies that may restrict which treatments are covered, which medications are approved, and how frequently patients can be seen.
These restrictions are often influenced by financial considerations rather than the particular needs of an individual patient.
I prefer to make clinical decisions based on my assessment of the patient, the available scientific evidence, and a thoughtful discussion of treatment options.
Confidentiality Matters
Psychiatric treatment involves some of the most personal information a patient will ever share with another person.
When insurance is billed, diagnostic information and other details about treatment generally must be submitted to the insurer. Additional clinical information may sometimes be requested to establish medical necessity.
Although insurers are subject to privacy regulations, I believe patients should have as much control as possible over the disclosure of their psychiatric information.
Practicing outside insurance networks allows me to avoid routinely submitting claims on behalf of patients, although patients who seek out-of-network reimbursement may still need to disclose information to their insurers.
Time Is an Essential Part of Good Psychiatry
Good psychiatric care requires time: time to listen, to understand a patient's history, to consider alternative diagnoses, and to evaluate the benefits and limitations of different treatments.
Insurance reimbursement can create financial pressures to see more patients in less time.
I have chosen a practice model that allows me to determine the length and frequency of appointments according to clinical considerations rather than reimbursement schedules.
This is particularly important in psychiatric evaluations, complex medication management, and second opinions, where a careful review of a patient's history can make all the difference.
The Question of Cost
I recognize that paying directly for psychiatric care can represent a significant financial burden. Not everyone has the resources to do so, and I do not believe that excellent psychiatric care should be available only to those who can afford private treatment.
Many patients have out-of-network benefits that may reimburse part of the cost of their appointments. I can provide documentation that patients may submit to their insurers for possible reimbursement, depending on their individual coverage.
My fees are discussed openly, allowing patients to make informed decisions about their care.
A Deliberate Choice
After many years practicing psychiatry in a variety of settings, including hospitals, community mental health organizations, and private practice, I have come to place an increasingly high value on clinical independence.
My decision not to participate in insurance networks is ultimately about preserving the kind of physician-patient relationship I believe makes good psychiatric care possible.
It allows me to practice psychiatry in the way I think it should be practiced: thoughtfully, independently, and with the interests of the individual patient at the center of every decision.
At the end of the day, it should be clear where my loyalties lie. I have no interest in working for an insurance company. It is both a privilege and an honor to work for my patients and their families.