I need to see my shrink more often.

April 16, 2008 12:46 PM

Doctor-insurance filter: Any doctors out there have experience with becoming an "in network" provider for United Health Care? Can I convince my doctor to do this?

I needed to see a psychiatrist rather urgently (med. management + some other stuff) and looked up who was in-network for my insurance co., United Health Care. Unfortunately the doctors on the list who I called were not accepting new patients. But I got a call back from the receptionist saying another doctor in their building was open. Assuming (I know, stupid) that he was also in-network, I started seeing him (fall '07). I didn't realize he was out-of-network until almost $2500 dollars later (spring '08). I paid my in-network co-payment at every visit, but for out-of-network, they only cover 50% after the first $1000. I talked to my dr. about this, we decided to ask for a gap extension (allowing him to be treated as in-network since we had established a relationship); however, my employer doesn't allow that on their plan. So now I pay $100 (which is 50%) at every visit, meaning I can only afford to see him every other week where my visits used to be weekly. It sucks, but I've been dealing with it.

My husband and I just decided we are moving later this summer. So there are some things I want to tackle in therapy before I leave town. Obviously more frequent visits would be helpful but I can't afford it. So I'm going to ask him if he would consider trying to become in-network so I can see him weekly again.

So I'm wondering if he'll feel that's too much hassle. I'm thinking it would mean he makes more money (depending on the rate the insurance pays---on top of that I would pay co-pays of $40 4x/month instead of the $100 2x month that I pay now). But paperwork is not what he (or anyone else) lives for, so how can I convince him this would be beneficial, even though I am a relatively short-term patient.

Is UHC a pain to deal with, as a doctor? Do they pay less?

Obviously I will ask him directly, but I wonder if anyone out there has any experience going from out-of-network to in-network, especially with UHC?

posted by hulahulagirl to health & fitness (5 comments total)

i have no answer to your specific question, but have you asked him at all if you could get a discounted rate? i've had a few doctors do this for me (that i had long standing relationships with). they billed insurance as they normally would have, but just billed me whatever (so maybe $40 a visit in your case). it's not a bad idea to ask.

i have uhc and it is the worst insurance i have ever had. i hate it so so so so so much.
posted by misanthropicsarah at 1:46 PM on April 16, 2008

There's an investigation on by the NY attorney general's office into how UHC deals with out of network payments. As I understand it it's about UHC being shifty about how they set the amount they'll pay out of network doctors.

I have a similar situation with UHC and an out of network doctor - I was referred to my doctor by another doctor within the same practice, who did take United, and I didn't realize the new doc wasn't in network for a little while. The office has cut me some slack on pricing, so I agree that that is a possibility. On the other hand, the front desk people there have given me the impression that United is very difficult to deal with. I would guess that getting a discount on the fee is as likely an outcome as getting him to join up with UHC.
posted by yarrow at 2:16 PM on April 16, 2008

The process of becoming affiliated with UHC's network would take a while - it isn't just a matter of signing a contract and he's in. Even if he's willing to join their network, it could easily take too long for you to benefit much. Not sure what laws are in place in Hawaii about this, there could be other statutory constraints that would speed or slow the process. Email me if you want a little more information.
posted by dilettante at 2:49 PM on April 16, 2008

I work for a cardiac sub-specialist in California's south bay area. We (and most of the cardiologists I know) don't contract with UHC because they pay specialists less than what Medicare pays. I know lots of family practice docs who are perfectly happy with UHC, except for the fact that they can't find any specialists who take it. Family practice docs don't do specialized procedures, so they bill less than specialists, so UHC probably pays them fairly competitively. You can ask your current doc if they'll sign up, but reimbursement is so low for most docs, I doubt he/she will be interested. My former therapist took insurance for about 6 months before she told me that the amount of time she spent in billing and chasing reimbursement wasn't worth the actual reimbursement when it finally showed up. I know therapy is expensive, but is the extra $$ really out of your reach? Is there any way for you to come up with the extra $$, knowing it would not be long-term? Have you discussed this with your therapist? Would he/she be willing to charge you on a sliding scale knowing it's not long-term? Getting quality healthcare with non-quality insurance sucks. Despite knowing how all of this works, the best insurance my boss can afford for me and our nurse is crappy at best, so I can sympathize.
posted by dogmom at 7:34 PM on April 16, 2008

Thank you for the answers everyone, much more helpful than I anticipated.

Yeah, so at my appt. yesterday we briefly discussed my bill and how I'd rather not pay, I made a joke about him wiping my bill clean, but no real discussion on whether or not he can take a reduced amount for the bill. I didn't ask outright and he told me he's just as uncomfortable talking about it as I am. He's only a couple years out of med school so I imagine he's not exactly raking it in. So maybe next time I will be brave enough to broach the subject of a discount.

I know therapy is expensive, but is the extra $$ really out of your reach? Is there any way for you to come up with the extra $$, knowing it would not be long-term?
Yeah, I'm paying pretty much all I can afford at this point. Neither my husband or I make much, we have some other debts to pay, etc. If it was a life-and-death situation I could probably scrape together the extra payments and go every week again.

Thanks again everyone.
posted by hulahulagirl at 2:00 PM on April 17, 2008