“I was referring them out, but they could just not get access to any mental health providers,” Dr. Zhu stated. One of her sufferers known as greater than a dozen suppliers earlier than getting an appointment, she stated.
Insurers say their objective is to supply a wide selection of psychological well being providers. “Everyone deserves access to effective, affordable and equitable mental health support,” Kristine Grow, a spokeswoman for AHIP, a commerce group representing the insurers, stated in an electronic mail.
But Ms. Grow criticized the Health Affairs examine for not evaluating the plans with conventional Medicare and for not inspecting different kinds of psychological well being providers out there to sufferers that may be offered by different clinicians or through telehealth. “In essence, this study uses a very narrow definition of mental health clinician to prove a pre-existing thesis about Medicare Advantage,” she stated.
More broadly, regulators and lawmakers have voiced issues that individuals within the personal Medicare plans will not be getting the providers they’re entitled to beneath the federal program. Critics have lengthy complained about insufficient entry to psychological well being providers.
Senator Ron Wyden, the Oregon Democrat who leads the Senate Finance Committee, held a listening to in May about so-called “ghost networks” of psychological well being suppliers, wherein most of the clinicians listed within the Medicare Advantage plans’ directories are usually not, the truth is, accepting sufferers. His employees carried out a secret shopper survey and will solely receive an appointment 18 p.c of the time.
The Health Affairs examine might have overstated the provision of psychiatrists as a result of it solely checked out which suppliers have been listed within the plan’s listing, Dr. Zhu stated. “It likely paints a rosier picture,” she stated.
Doctors could also be unwilling to take part in Medicare Advantage plans due to the low funds paid by the insurers, coupled with the entire required paperwork, stated Dr. Robert Trestman, who’s the chairman of the council on well being care methods and financing for the American Psychiatric Association and testified on the Senate listening to. “Many of the challenges and frustrations are emphasized in the Medicare Advantage plans,” he stated.
Some insurers pay psychiatrists much less beneath their Medicare Advantage plans than conventional Medicare pays for a similar providers, the researchers stated. The plans may additionally have an incentive to contract with a smaller group of medical doctors to have extra management over the price and care being delivered, the researchers stated.
Source: www.nytimes.com