On March 13 2013 08:47 haduken wrote:Show nested quote +On March 13 2013 07:37 LaNague wrote:
So, why are you listed as accepting that insurance then? +1 OP you start off saying that people contact you because somewhere you are listed to provide care to patients on Cigna insurance and you end by saying that you choose to not provide care to Cigna patients??? Are you doing this purely on cost if so why not remove Cigna from your operation all together? or is advertising Cigna part of the requirement to remain as a in-network provider?
Hi haduken and LaNague - You hit on a good question. I wish I had a more interesting answer, but here it is: People inevitability change insurance companies from time to time, often through no choice of their own.
Whether it be a marriage, divorce, job change, or a decision by their employer to switch insurance companies it is common for people's insurance needs to change. As I build a relationship (sometimes over years) with my patients it is my desire, and feel it is my responsibility, to provide a continued treatment if they are willing and I am able to. Sometimes that means someone losses their insurance coverage all together and we work out a reduced fee while they regain coverage (or until treatment is no longer necessary). Sometimes that means I accept an insurance that does not reimburse me very well (such as Cigna or others).
So while I try very hard to not accept new patients that have Cigna insurance (there are exceptions though), I will continue with patients who switch to Cigna.
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On March 13 2013 06:32 HardlyNever wrote:Show nested quote +On March 13 2013 00:22 ProjectiveID wrote:On March 12 2013 06:52 HardlyNever wrote:
Interesting read. I think this sort of exemplifies how screwed up health care (in general) is in the US, when even insured patients have to "shop around" like they are buying a car.
One thing I find odd is that you knowingly refuse someone that is obviously in need of your "medical attention," citing dollars and cents, while at the same time try to argue how important and necessary mental health care is. While our health care system is screwed up, most hospitals or doctors wouldn't turn away a physically injured patient over dollars and cents (mostly because it is illegal in most cases). Although it does happen, unfortunately.
If you want your profession to be taken more seriously (and I, like most Americans, don't take it that seriously, excepting some extreme cases) then maybe you should treat it more like a real medical profession than a business practice (that advice could go for a lot of "real" medicine as well, though).
Be a part of the solution, not the problem? Hi HardlyNever - Thanks for your feedback and thoughts. I'd be interested in hearing you expand on them a bit. I'm always interested in how psychology/therapy is viewed by people in other professions. In particular I wonder why it is that you feel it is difficult to take psychology (or just psychotherapy) seriously? While I do think the effort to better understand the human mind is a good thing, I don't put a lot of stock in the current practice as it is done, particularly in the US. It seems like we should be a long way from Freud and Jung at this point, but it doesn't look that way to me (from the outside looking in). Perhaps you think it is different with inside knowledge, or perhaps the profession just wants to convince you that you've come a long way, when we really haven't. I guess it just feels like it is a long way from a "hard science." But I suppose you have to start somewhere. It seems like we are getting off track, though. Also, I think the psychology profession suffers just as much or probably even more from "symptom bloat" or "imaginary disease syndrome." I'm not sure what the technical name for it is, but I think you know what I'm talking about. Just like every month I see a drug for some new (physical) disease like "restless leg syndrome," I hear of some new psychological disorder that I should now "respect" as a "medical condition" and not "that person is just an asshole/unstable/ could use a good dose of something other than drugs." It seems like half the kids these days are on some sort of drug or have some sort of "condition" that they need special drugs or treatment for (ADD, ADHD, blah blah blah). They even tried to tell my parents I have "ADD" when I was like 2. 2 years old, and you're going to diagnose that (I don't btw, I'm a pretty laid back dude that can focus with no problems). I'm pretty sure it was just an excuse to sell more drugs. I think the "heart" is in the right place, but it has become a business, not a medical practice (as this blog illustrates). It isn't about helping people or understanding the human mind better anymore, it is about creating symptoms and creating drugs and/or treatment (for profit) that can treat these symptoms. Then wrapping it all in the shroud of "medical necessity." Do you even take your practice seriously? You just said you turned away someone who you knew needed help, because you could make more money elsewhere. This is one (of many) reasons I switched from pre-med back as an undergrad; I felt like the medical profession (at least in this country) was about profit, not well-being. Psychology, in my opinion, is probably the worst offender in this regard. That is why I don't respect it that much.
Hi again - thanks for taking your time to share your thoughts. I think we both share some similar frustrations with mental health treatment in the US.
You touched on one of my biggest frustrations: the use of medications. The pharmaceutics companies have done a brilliant job at somehow convincing us that an emotional signal must be treated with a chemical solution. I would say it is pretty common now for someone to assume the clear and obvious treatment for depression is anti-depressants.
I'll throw out there that I am very glad we have psychotropic medications. I have seen them literally save lives and in some cases are the very best treatment that can be offered. However, in many many more cases medications simply dull the symptoms and as a side effect rob the patient of the chance to live more fully.
The antidote to suffering is not to just try to suffer less in any way possible, it is to wonder why it is the suffering is there to begin with. There is hope in understanding it and not avoiding it. I could say a lot more about it and you sharing your thoughts has inspired me to perhaps make a new entry on this topic alone, so i'll stop here for now.
The second frustration you bring up: ADHD diagnosis. It breaks my heart to see this abused the way it is, and it sounds like you were a victim of that abuse. Again, I could, and probably will, write a whole new entry about this, but I'll say a few things here. First, ADHD is a diagnosis that is heavily influenced by both pharmaceutics companies and insurance companies. It is a diagnosis that is primarily treated with medications (a win for Big Pharma) and medications are a cheaper treatment than on going therapy (a win for insurance companies).
Over my years of practice I regularly see patients who have received a diagnosis of ADHD by another provider, usually a primary care physician. If I ball park it, I would say that I disagree with over 90% of those diagnosis'. The vast majority of what I see are patients who have something going on (perhaps some depression, some anxiety, or some other transition such as starting a new grade or a new school), that creates the symptom of difficulty focusing. In other words, providers tend to get caught up in the one symptom (a lack of focus) and don't bother to wonder why that might be.
You brought up some other good thoughts too, and I'm hoping I'll get a chance to come back to respond to those. I did want to clarify though the difference between a psychologist and a psychiatrist. It sounds like you have some experience with mental health care so this might already be clear to you, but in case it's not (or for others) here it is: Psychologists are not medical doctors and as such, we cannot prescribe medications (there do exist some rare exceptions). Psychiatrists are medical doctors who have undertaken specialty training in mental health and who do prescribe medications. In other words, in my role as a psychologist I would never advise or suggest a patient to take a certain medication. Not only am I not trained in it but I would put my license at risk. I might suggest they speak with a psychiatrist if I feel medication may be an important part of treatment, but that is a fairly rare recommendation, for me at least.
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EPT
