Why is it so hard to schedule an appointment with a psychiatrist?

In my last post, I wrote about some of the reasons that many psychiatrists and therapists do not accept health insurance in their clinics. I explained how insurance companies mandate the types of treatment, and frequency of treatment in order to decrease their own costs, often at the detriment of the patient.  However, I want to expand on this topic a bit further.

Let’s say that you have a major health plan, also known as “commercial” insurance. You probably pay a lot of money to maintain this health plan, and for the most part, you are able to find doctors and specialists when needed. However, what if you start noticing symptoms such as sadness, low motivation, low energy etc.? A quick google search of these symptoms will likely suggest you meet with a psychiatrist, as you might be suffering from depression.

Naturally, you may reach out to your health insurance company for a recommendation or referral. Here is where the problems start. It can be hard, in fact very hard, to schedule an appointment with a psychiatrist that your insurance company recommends.

This study found that only 33% of the time, the psychiatrist’s office will even take your call. The same study revealed that only 26% of the time patients are able to actually schedule an appointment.  

So why is that? One major hurdle to accessing mental health care is the prevalence of “ghost networks” provided by health insurance companies. Essentially what is happening here is that insurance companies publish long lists of “available” psychiatrists that allegedly accept their health plan. However, when you actually call the doctors on this list, the doctors are dead, retired, out of network, or not taking new patients. One study found that some numbers on the list were not even a doctor’s office at all, the number was for a McDonalds!

Reaching out to a mental health professional takes courage. It is disheartening to call around to office after office, only to find out that what at first appeared to be a long list of available options, is actually quite a short list. It could take you hours to figure this out.

I’ve seen this personally in practice. I’ve spoken with people on the phone who tell me that they have called dozens of offices (sometimes more), searching for a psychiatrist with availability. I’m often told that I am the first doctor to call them back.

So why would an insurance company allow these ghost networks? One theory is that perhaps it’s simple neglect. The lists just aren’t updated in a timely fashion. Another theory is that perhaps insurance companies may have little motivation to update and improve their lists. If it’s very hard for someone to find a psychiatrist, then the insurance company simply won’t have to pay for psychiatric treatment.

I’ll be honest, I don’t know the reason behind these “ghost” networks. However, I do find them unacceptable, as they create barriers to care. In my clinic, I am transparent about my fees and availability. Though I do not take health insurance, I work with my patients to provide a “super bill”, so that they can submit for reimbursement if their plan has out of network benefits. I also return phone calls to any prospective patient within one business day.

Struggling with mental health is hard enough as is, I want to be part of the solution, not the problem!

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