Anniversary Reflections, Insurance, and Lack of Access to Mental Health Care

It has been a little over a year since Treehouse Child Psychiatry opened its doors, and I have to say that I’ve been blessed to have had a great year. I’ve met many fantastic patients and families, learned a lot about running a business, and feel like I have done some good in the world.  There were some headaches with the property association not approving of our sign and having to have a new one printed, and with figuring out how to just function as a solo doctor, but overall I feel like everything has turned out pretty well for the first year of business.

When I first opened, I had made it my goal to at least try to take some insurances. Now, some of you may not know (but I bet most of you do) that the shortage of psychiatrists, and especially CHILD psychiatrists is extreme.  Most practices in the area have wait times of over 6 months for a new patient to see a doctor. I’m told by friends that it’s similar in other areas of the country. Los Angeles, for example, has twice as bad a shortage as Charlottesville per capita.  As a result, few child psychiatrists want to deal with the headache of taking insurance. The payments typically pale in comparison to the average cash rates in the community, and it introduces several paperwork headaches and need to hire extra staff, which incurs extra costs. So, more work, most expense, and less money.  Why isn’t every doctor signing up for that?

The reality is that many patients simply can’t afford the cash rates of child psychiatrists. The going rate in Charlottesville is around $250-300 an hour, or $125/mo for monthly follow up visits.  That’s around $1500 per year.  It’s a lot of money for many families.  Now, for doctors, the shortage is so bad, that we are not hurting for patients even with the cash rates.  But it still leaves many families out in the cold.  So, I made the choice to try my hardest to take insurances.  I requested rates and contracts from all the major insurers when I first opened.  One insurer’s rates were simply too low to even be considered. They were so low that I even emailed them to ask if it was a typo or if I was reading it wrong.  They wouldn’t negotiate.  I had Creigh Deeds file a complaint on my behalf with the insurance board, because since the advent of the ACA (Obamacare), insurance companies are required to pay equal rates to mental health doctors as other medical doctors.  Still, they’ve found creative ways around this provision.

I eventually decided that the rates of two insurers were doable. Optima offered me very fair rates and I signed their contract without much hesitation. Aetna’s rates were less good, well below my cash rates, but I felt they were fair and I could make them work, so I signed the contract and waited.  And waited.  And waited.  It took around 6 months for the contracts to get processed.  I gave up hope that I would ever hear anything and accepted my fate as another cash psychiatrist.  Then in May, I found out that both insurers had processed my contracts and I was now in-network for both.

The Optima process was fairly simple. I made an online account with Optima and waited for the patients to come.  And waited.  And waited.  And…I’m still waiting.  The Aetna patients came. In droves. But we hit a snag. I filed my first claims and they all got rejected as out of network.  I called in early June.  The Aetna rep said that it was a computer glitch and they’d submit a “ticket” and get it sorted out within 10 days.  2 weeks later, I submitted more claims.  All rejected again.  I called again.  Each time I call it’s an hour on the phone. That’s an hour of patients who aren’t getting seen. Lost income for me, but more important lost care to our community. Fast forward to now. I have yet to be paid a dime by Aetna. There’s still a computer glitch showing me, like Schrodinger’s Cat, as both in and out of network simultaneously.  It’s honestly been a nightmare. It’s sometimes hard not to imagine that they’re doing this on purpose. A solution is still pending.

Needless to say, our system is broken. People who need mental health care cannot afford or access it. I am happy to announce that we are taking steps to fix this. My wife and daughter are founding a non-profit organization, Children’s Mental Health Fund (CMHF), to address this issue.  Our goal is to raise money from donations to pay for the care of needy children directly with cash pay psychiatrists.  If we can even pay for a year of care for one child ($1500) it would make all the difference in the world.  That’s 300 people giving $5 each.  I think we can do that.  I think we can do better.  Please note, I’m not asking for money…yet. The non-profit is not yet up and running. But don’t worry, we’ll let you know when it is.

In the meantime, the adventure continues.  I am looking to hire my first employee, a medical assistant or nurse to help with front desk duties and collecting patient vital signs.  If you know anyone with a medical certification who wants a part time job, send them my way.  I am hoping to hire a therapist or two, and possibly another doctor in the next year or so as well.  Maybe by next year, my issues with insurance will be sorted out too, we’ll see 🙂

Dr. Heck