A veteran psychiatrist shares his view of how private health insurance companies dictate — and limit — ADHD care in America.
The United States is the only first-world nation that does not provide basic health care to all its citizens. The roadmap to universal health care exists and public opinion largely supports it. However, health care is so incredibly profitable for American insurance companies and political campaigns that proposed reforms are practically guaranteed to fail time and time again.
use the worst possible system to fund patient care. The only way to perpetually increase the profits demanded by shareholders is to deny legitimate claims or otherwise create obstacles that prevent or delay payments to providers. This system does not incentivize efficient care; it disincentivizes delivering care altogether.In the 1980s, as technology made the delivery of care more efficient, insurers sought ways to increase profits. This was largely accomplished by obstructing the delivery of care or denying care outright – and it changed physician behavior. If a clinician knew that a prescription for the cheapestwould be approved swiftly and without question, but a superior and more expensive time-released formulation would be contested or denied, the clinician would prescribe the insurance-preferredIn Colorado, where I live, a majority of private mental health practitioners no longer accept any insurance plans largely because thedon’t pay parity rates or pay for care that was pre-authorized. It can take months for insurers to pay claims. These insurance company practices have made access to patient care difficult, if not nearly impossible. In Colorado, few clinicians have the training and experience necessary to adequately manage ADHD in children and adults. If a patient cannot find an experienced clinician and access good care, they stop running up clinical office and pharmacy charges — a win for the insurance company and its profits, and a loss for people who go untreated. For every practicing clinician who still deals with insurance, there are likely one to two people in their office who do nothing but fight to get their legitimate claims submitted and paid. This extra cost gets passed on to the patient in the form of higher out-of-pocket costs at the point of service. Being obstructive and slow to pay claims is profitable in other ways, The longer the insurance company can hold onto billions of dollars of premiums, the more investment interest those premiums will earn. Insurers also know that people with mental health conditions are much less likely to appeal a denial of care. Life is hard enough for people with an ADHD nervous system. They can become overwhelmed by the intentional complexity and obstruction of legitimate care, A single complaint by a patient to a lawmaker or regulator is rarely noticed. A million complaints could start a revolution.Contact your federal and state representatives about the problems you are having with your insurance company. Report issues with your insurer to your state’s Department of Insurance and copy your governor’s office. Report complaints about your insurance company to your human relations department, which chooses employee benefits. When a claim is denied, immediately demand a peer-to-peer review between your clinician and the company’s medical directors.If you are fighting to get your clients the best care you can provide , you must be aggressive. Each time you contact the insurance company, keep a log and do the following:Get the person’s full name and professional licensure. Find out in which state they are licensed in case you want to make a complaint about practicing outside the scope of their license or for obstruction of appropriate care. As you get passed from person to person, ask each one for their credentials and what gives them the training, knowledge, and experience to make decisions about your patients’ care. How many people withWilliam W. Dodson, M.D., has been a board-certified adult psychiatrist for more than 27 years. He does not accept insurance.ADHD Medication Use Lowers the Risk of Suicidality, Criminality, Drug Misuse, Car Accidents: StudyStay informed with trusted information, resources, and support delivered straight to your inbox. Choose the newsletters that interest you most.
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