Payments/Insurance

To all my patients regarding change in Insurance Policy July 1, 2015

Twenty-two years ago when I started providing psychiatric services in Puget Sound, I initially accepted all insurance and government medical coverage. Over time, as insurance policies became more aggressive and “anti-physician”, I gradually felt forced to accept only the major carriers. But now, I’ve determined I must convert entirely to a fee for service practice. So, as of July 1, 2015,1 am canceling all remaining insurance contracts.

What does this mean to you?

If you are currently getting services privately, that is, without using insurance, not much will change. If you are currently using insurance, you may continue to use your insurance for reimbursement after our sessions.  At each visit I will provide a statement of services and the time involved. There may be a difference in your out-of pocket expense, depending on how well your insurance covers “out of network” physicians. The new office policy will be simple. Charges will only depend on the time spent with you in the office, and on your behalf between visits. There will eventually be no mechanism for me to carry debt and so payment will be expected in full at each visit. For those that want to get reimbursement from their insurance, you will be provided with a bill that attempts to convert your services as favorably as possible into a code currently used by most insurance carriers.

How did it come to this?

There are many factors. Today across the country about half of all psychiatrists no longer accept insurance. The level of intrusion by insurance carriers into the day-to-day practice of medicine, especially in psychiatry, has steadily increased over the last 20 years. Denial of payments to doctors (for more “reasons” than you can imagine) is now common. Denial of care through insurance requirements for “prior authorization” for medications, tests, psychotherapy, etc. force physicians and their staff to spend hours every day on behalf of their patients battling insurance companies and their policies. Of course, insurance does not reimburse for the time involved, making it more likely the patient and doctor will “go away” so the insurance company can profit more. Recently insurance companies have begun using third party companies to audit medical records, after the fact, looking for any grounds to claim “over-billing” – then take back alleged over payments from their future obligations. And for the “privilege” of agreeing to contract with these insurance companies, physicians accept a significant discount off their fees. Treatment decisions have now become heavily skewed by the insurance industry through the use of the “doctor hassle factor.” Nowhere is this worse than in psychiatry. I trust you have found our work together valuable and hope you will continue. I look forward to providing high quality and efficient medical care on your behalf.

Sincerely,

Lester M. Sandman, M.D.