A very American healthcare problem

August 15, 2019 4:18 PM

I've had it with Medicaid. I need to see a doctor and a psychiatrist now, not months from now. What are my options?

I'm on Maryland Medicaid, and I am very tired of waiting to be seen by a doctor. I have physical and mental health problems that need to be addressed. I need to see a doctor, I need to see a psychiatrist, and I'm sure I'll need referrals to specialists (like a sleep specialist, etc). Once I get any referrals, it will then be yet more waiting to see them. Maybe I'll see a sleep specialist by Christmas if I'm lucky. And there's no guarantee they won't be overbooked and overworked, as has been my experience with free healthcare in the past.

Technically I have a PCP at an FQHC, but I've never been able to reach her office (I called multiple times this afternoon, and the person on the phone kept saying "this is the overflow line, try calling again in a few minutes"). I made an appointment with a doctor at another local FQHC -- the wait is three months. I had a very bad experience with a FQHC psychiatrist, and the wait to see a new one is two months, pending approval by the director of the clinic, who has yet to contact me.

What are my options besides what's available on Medicaid? Can I just pay to see a decent doctor? Like, can I make my pipe dream come true and just pay my way into decent healthcare (defined in my mind as doctors you can see without months of waiting, who have more than 10 minutes to see you)? Years ago I went to a doctor when I was uninsured, and she charged me an uninsured rate that was like $150 per appointment. Is that still a possibility anywhere? Would I be on the hook for the bills for tests and whatnot?

Should I try to go to urgent care, even if this isn't technically an urgent care thing? I know urgent care doctors get shockingly little time to see their patients, but it's better than nothing, and maybe they could write a referral? Would they even see me?

Clearly I'm beyond the point of patience, here. Do I have any options besides Medicaid, or do I just need to stick with this system and hope it works out eventually? I just don't know what I can do in the meantime.

posted by shapes that haunt the dusk to Health & Fitness (20 answers total)

Yes, you can just pay cash to see a doctor. A few doctors don't even take insurance at all, just to avoid the hassle. "Self-pay" is the term you want to use for googling and when calling around to check on rates.
posted by slenderloris at 4:32 PM on August 15, 2019 [4 favorites]

You might try calling Healthcare for the Homeless (which isn't just for homeless). They might be able to recommend something even if they aren't a good fit.
posted by postel's law at 4:40 PM on August 15, 2019

Does your existing Medicaid plan have a nurse line? If so, there would be a number for this on your ID and in your member manual and on the website. They are typically good at chipping away at your more immediate needs, so you can at least make some progress in the short term.

Depending on the plan (I can't remember whether Maryland falls under this), you might also have options like telehealth, which would allow you to connect to a specialist or mental health professional online or over the phone, perhaps sooner than waiting for a traditional appointment.

I know this is frustrating. You can do this. :)
posted by mochapickle at 4:44 PM on August 15, 2019

You can definitely just go to urgent care, tell them what your issue is and let them tell you if they can help or not. Ask them if they accept Medicaid and see if they'll bill them for you. Call up a bunch of psychiatrists until one can see you soon and then write them a check at the end of the session until you find one you like.

In my experience getting access to healthcare without insurance is much easier because there's no middle man. Doctors just want to know that somebody is going to pay, who it is doesn't really matter.
posted by bleep at 4:47 PM on August 15, 2019

Some states have laws that say that providers are not allowed to charge Medicaid clients, even if hte provider is not in network with Medicaid. You might argue that people should be allowed to pay privately if they want but the logic is that if you are so poor you have to be on Medicaid that nobody should be expecting you pay anything out of pocket for care. I don't know if Maryland is one of those states or not but you should probably find out before you invest too much time in trying to find someone.
posted by metahawk at 5:31 PM on August 15, 2019 [1 favorite]

Resident clinics usually see primarily people with Medicaid. Your doctor will be in training, but they will be supervised by an attending physician. I am a resident, and the clinic I see patients in does not have a many month waiting period. Try the nearest academic medical center.
posted by i_am_a_fiesta at 5:44 PM on August 15, 2019 [4 favorites]

Intake appointments for new patients have a longer wait time. I have MA in PA and it took me like 6 months to see my PCP, but after that could easily schedule an appointment within a week or so of calling. Do you have friends on medicaid in MD? Maybe ask if they can refer a doctor to you. Also, if you go to the emergency room, you have to be treated, you might wait hours to be seen but that's better than weeks or months and if you're prepared it might not be so bad. Also seconding community health centers/clinics or Urgent Care.

I had the same issue with MA in PA where a lot of the numbers I was given for providers were bad, they stopped accepting MA, etc. I had to call tons of offices in order to land a receptionist and an appropriate office.

Also maybe try to prioritize your needs. I had a PCP when I was in college who prescribed me antianxiety medication, especially because I'd used it in the past. If you have a record of taking a type of medication you'd like again for something like that, bring it to your PCP and just see what they'll say. You might be able to kill 2 birds with one stone.
posted by erattacorrige at 5:58 PM on August 15, 2019 [1 favorite]

On the ThereIsHelp MeFi Wiki page, there are a few resources listed that may provide some assistance, including:

For health insurance-related access and care coordination issues, you may want to find a community health worker in Maryland.

For mental health care and medication, you may want to start with the NAMI Helpline, which is a free service that can be reached at 1-800-950-NAMI (6264) or [e-mail] for information, referrals and support for people living with a mental health condition.

You may be able to find more accessible psychiatric care if you look for clinics and practices that have psychiatric RNs (PMHNP) and accept Medicaid. I don't think Medicaid requires a referral from a PCP for mental health care, but the clinic or practice will let you know if a self-referral is possible.
posted by Little Dawn at 6:47 PM on August 15, 2019 [2 favorites]

Yes, you could self-pay with a doctor in private practice. The doctor may offer a discounted rate, but any tests or procedures they order will likely be expensive.

Or, skim this list of sliding-scale clinics in Maryland -- some clinics also accept Medicaid.

Depending on which company provides your Medicaid coverage, the company will have different access points for care; for example, under Amerigroup's "Getting Care 24/7" behavioral health information: "You do not need to see your PCP before getting behavioral health services. We can help you find mental health and substance use services. Call us toll free at 1-800-600-4441 (TTY 711)."

Here's the information page for Maryland's Behavioral Health Department ("Maryland’s Public Mental Health System (PMHS) provides inpatient and outpatient mental health services for individuals with mental illness, those with Medicaid and for others,..."), with directions on accessing mental health care, and another 24-hr reach number: 1-800-888-1965.
posted by Iris Gambol at 7:40 PM on August 15, 2019 [4 favorites]

Yeah, my partner is on Medicaid and the local medical college hospital (which also happens to be the best hospital in the area, period, it definitely doesn't feel like a "teaching" hospital) gets them in very quickly on lots of things. So I would see if those take Medicaid. Big hospitals in general are a good bet, because they see both Medicaid and privately insured patients, and to my understanding don't discriminate between the two. At least I've never seen that happen, and my partner and I both see lots of different doctors at the same hospital (they have Medicaid, I have private insurance). Even if they don't take Medicaid, many hospitals have financial assistance plans, so you could see if you qualify for that and try and see someone via that form of financial aid, which would widen your options.

That said, many specialists have months long waiting lists regardless of whether you're on Medicaid or not. My neurologist, that I'm established with, can't see me for 9 months. Neuropsych testing took 6 months. Dietician, two months (and in this case, my partner and I both needed to see dieticians for different reasons, and both couldn't get scheduled until 2 months later--on the exact same day, so Medicaid vs private didn't seem to make a difference here). A wait time of three months is not actually that unusual for a psychiatrist. I don't think it's unique to Medicaid, healthcare wait times in the US just suck. If you can't wait that long, though, yes, it would be appropriate to go to urgent care. There are some things they can try to do there, and if your trouble is you can't get in to see your GP, they should be able to provide the referrals you need.
posted by brook horse at 7:50 PM on August 15, 2019 [3 favorites]

By any chance are you in the DC-adjacent part of Maryland? You might have luck with The Women's Center, which despite its name serves both women and men with subsidized and free care. I don't know about their wait times, but I do know that they provide high-quality and affordable care.

The DC office is on Vermont between K and L ... it's in the building where Juice Joint used to be, if that helps you visualize.
posted by mccxxiii at 8:10 PM on August 15, 2019

Response by poster: Yes, DC-adjacent.

I'm confused about wait times. When I was in California, I was able to start seeing a psychiatrist twice a week almost immediately after I got the referral. I went to multiple neurologists, a gastroenterologist, and a dietician within a week or two of getting each referral. I never had to wait very long at all. Was that kind of experience really so unusual? I'm not much better off if I go to urgent care and they refer me to someone I can't see until November. I seriously don't know what I'm going to do if I really have to wait that long to see people.
posted by shapes that haunt the dusk at 8:20 PM on August 15, 2019

Resident clinics usually see primarily people with Medicaid. Your doctor will be in training, but they will be supervised by an attending physician. I am a resident, and the clinic I see patients in does not have a many month waiting period. Try the nearest academic medical center.

This is good advice. Try local academic medical centers -- all will have training clinics that offer high quality primary care, and they will give your issues the attention they deserve. Don't go to an urgent care seeking "referrals." The whole idea with a referral is that your PCP follows up on the recommendations from the referral visit; if no PCP then that falls apart.

Medicaid doesn't really pay PCPs sustainably. Thus it's harder than it should be to use Medicaid to see a PCP.
posted by killdevil at 8:34 PM on August 15, 2019

Because no one has mentioned it, not because I recommend it or its a good idea, you can always present to an Emergency department, which medicaid will cover. Note that this significantly increases your risk for inpatient hospitalization, but if you need a psychiatrist and NOW and you are in crisis you may spend a few days in a hospital but you will see a psychiatrist and get enough meds to get you to follow up with a provider. Definately try your behavioral health line first.

If you don't qualify for inpatient hospitalization you may or may not actually get evaluated for meds. My hospital system fast tracks ED admissions for outpatient appointments but yours may not.
posted by AlexiaSky at 8:39 PM on August 15, 2019 [1 favorite]

As a general rule, do not go to the ED for a psychiatric issue unless you're suicidal, homicidal or acutely manic or psychotic. We won't be able to do much to help and you may be stuck with a big bill for useless psychiatric screening labwork.
posted by killdevil at 8:48 PM on August 15, 2019 [5 favorites]

I'm confused about wait times. When I was in California, I was able to start seeing a psychiatrist twice a week almost immediately after I got the referral. I went to multiple neurologists, a gastroenterologist, and a dietician within a week or two of getting each referral. I never had to wait very long at all. Was that kind of experience really so unusual?

Yes, that's extremely unusual IME, access to psychiatry is a train wreck in a lot of places. If you are part of any local social/community groups - Slacks, Discords, email lists, things like that - you may get useful recommendations for psychiatrists through those channels. Some of those psychiatrists may find new clients almost exclusively through word of mouth and accept no insurance - only self-pay or sliding-scale pay.
posted by bagel at 9:04 PM on August 15, 2019 [3 favorites]

Technically I have a PCP at an FQHC, but I've never been able to reach her office

Any chance you could go over there physically to make an appointment?
posted by trig at 9:41 PM on August 15, 2019 [1 favorite]

Not sure if this will actually work but with private insurance I’ve used Zocdoc to find immediate appointments.

A quick search using a DC-adjacent Maryland city and Amerigroup Maryland Medicade shows available PCPs.

You could try booking an appointment this way, then call the MD’s office and see if it worked.
posted by sciencegeek at 2:49 AM on August 16, 2019

My experience with pretty decent insurance has been that there's still usually a couple of months' wait forba new patient appointment. But also that you can often get on a wait list for cancellations and end up seeing someone sooner. So it would be worth getting yourself an appointment or two ASAP while you continue to look for faster options, and then you can cancel those appointments if you find someone who can see you faster.
posted by Stacey at 4:46 AM on August 16, 2019 [2 favorites]

I work at a mental health clinic in Arkansas, so I can only speak to our experience here, but it sounds like you may be running into similar issues in Maryland. We recently added several RNP to our group which dramatically decreased the wait times for appointments. Prior to that, it was a 2-4 month wait for a new patient appointment with a psychiatrist not only at our clinic but in most clinics around us. For us, a new patient appointment is an hour long, and followup appointments are 30 min long. Trying to find a 1 hour opening in a schedule that was pretty jam packed already was also part of the challenge. And all of this was without us taking Medicaid...it was for anyone who called us whether they had private insurance or cash money. Arkansas just doesn't have enough psychiatrists to go around...thank goodness we've embraced using RNPs recently! Last year we had 70 practicing child psychiatrists in the state....and we have 75 counties. That's just not enough providers!

I don't have specific Maryland advice, but I would call to as many places as you could to see when the soonest appointment is, and ask if they have cancellation lists they can put you on. I also don't know if it's worth it to go to a clinic that has you see a therapist first for your intake appointment. They gather your history, so it's possible that you can get a quicker appointment with the MD or RNP since the longer intake part has been taken care of. (I'm just guessing on that...some clinics around here require their clients to see a therapist first...we don't so I'm not sure how that plays out behind the scenes).
posted by MultiFaceted at 7:29 AM on August 16, 2019 [1 favorite]