“I’m not able to authorize payment.”
It’s a line I’ve heard many times in the five years I’ve been practicing psychiatry, so I was ready for it. I’d been on the phone for 45 minutes telling the insurance company representative how my patient came into the hospital emergency room so depressed he could hardly function. How he’d missed nearly every day of work for the last few weeks and was close to losing his job.
My patient was resilient and determined to beat his depression. He’d been looking for months for an outpatient psychiatrist who accepted his insurance. Unfortunately, many insurers pay mental health providers so poorly and make it so difficult to get compensated that nearly half of psychiatrists don’t accept insurance at all. Now he was on a six-week waiting list.
None of that mattered, though. A complex man dealing with complex issues had been reduced to a binary variable by his insurer: suicidal, or not suicidal. And because my patient fell into the latter category, he didn’t meet his insurance company’s “medical necessity” requirement. He could still come to the hospital for help, sure, but only if he were willing to pay thousands of dollars out of pocket for treatment.
My patient didn’t have that kind of money. He could barely make rent.
Before I decided to specialize in psychiatry, I assumed a person in need of mental health care would have the same access to treatment one has for medical conditions like kidney stones, pneumonia or seizures. Instead, mental health patients and their providers face a mountain of bureaucratic obstacles that other patients are spared.