Study Finds It’s Difficult To Get Psychiatric Care Around Boston

BOSTON — A study by Harvard Medical School researchers finds that even people with excellent private health insurance have trouble getting psychiatric care in Greater Boston.

The authors of the study, published in the Annals of Emergency Medicine, posed as patients with Blue Cross Blue Shield insurance and called mental health providers in the plan, saying they had been seen in an emergency room and needed a psychiatric appointment within two weeks.

Dr. Wes Boyd, one of the study’s authors, says the lack of a response was surprising.

“Twenty-three percent of the time we were told we needed to have a primary care doctor in the facility,” Boyd said. “Another 23 percent of the time we left two different messages at the facility on the phone several days apart and never got back.”

Boyd blames the slow response on low reimbursement for psychiatric services.

“To have obstacles this big for someone who is suffering from some form of mental illness, it’s really a very sad statement about reimbursement for psychiatric care,” Boyd said.

Blue Cross says the study is flawed and is just an attempt to pressure it to pay clinicians more.

“It comes at a time when everyone in our community is focused on: how can we do more as a community — the health plans, hospitals, physicians, behavioral health clinicians — to moderate the cost of care?” said Blue Cross spokesman Jay McQuaide.

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  • Ali Crehan

    If I could have gone through the radio after hearing the statement, “Blue Cross says the study is flawed and is just an attempt to pressure it to pay clinicians more,” I would have. Wake up, BCBS – the problem is real.

  • Selma buffalo

    here here……spin what you want… if you pay out of pocket…. you can get services in a nano second. what does BCBS have to say abt that?

    and since sick patients are time consuming…. much of this work is non reimburseable…. now the least experienced clinicans are providing home care…. and driving around patient to patient and reimbursement is 18.00 per hour….OR if you say you are really ill the group practices say we cant provide the comprehensive services you need…. and refer you to places that wont see you unless your PCP is there and there are openings once per month to see your therapist. Its a revolving door of  no not here ….no services for those  who are ill. Only the wealthy working and walking wounded get care…

    And children who have no voice its even worse as care is less and less accessible as clinicans get no benefits and are working in fee for service jobs.

  • TomGrinley

    “It comes at a time when everyone in our community is focused on: how can we do more as a community … to moderate the cost of care?” said Blue Cross spokesman Jay McQuaide.

    Is this the same BCBS that pays multi-million dollar severance packages to departing CEOs? The same BCBS that compensates Board members for serving a non-profit? The same BCBS that is sitting on huge accumulated net assets and still raising premiums?

  • Virginia D Reiber PhD, Boston

    I am a clinical psychologist in Boston, and in private solo practice since 1985. In response to the article, I first want to state that there are many superbly trained clinicians of different disciplines who practice in the adjoining towns very close to the center of Boston.  Many, but not all of those clinicians, take the BCBS PPO insurance plan. Secondly,  since BCBS constricts their HMO provider panels, this has a limiting effect on service access to mental health providers for HMO patients.  Third, if the survey includes only the large incorporated Boston hospitals which have mental health services, it is no surprise that the service dearth described in the article exists.  There is no internal data-based system within those incorporated hospital-based entities for formal referral to providers of patient services outside of the systems.  Finally, it has been many years since BCBSMA has been a true partner in good care of folks with mental illness.   NOT a customer-service business.  And, the publicly traded health insurance entities permitted to do business by the insurance regulators of the Commonwealth are much, much worse in regard to access of providers of mental health services. The current condition of mental health services in Massachusetts.  And our state is one of the best.

  • http://barkingdoc.com/ Maggie Kozel, MD

    A recent study by the American Academy of Pediatrics (AAP News 31 (7) 34) predicts that treatment of mental illness and
    mood disorders will soon make up 30-40 percent of a pediatrician’s
    office practice.  to put this in perspective, an earlier study in the journal “Pediatrics,” (105(6):e82) revealed that only 8% of pediatricians felt they had adequate training in the prescribing of antidepressants, but 72% actually did, because no one else was getting  paid to do so.  So where do we pediatricans and other primary care providers turn for prescribing information ?  To studies funded
    primarily by the drug companies that manufacture these medications. Our current approach to evaluation and treatment of mood disorders, although particularly disturbing, is only one example of how clinical practice is being shaped more by health insurers and pharmaceutical marketing than by medical science.  And it explains why fully 25% of US children are currently on chronic medication (2009 report from the IMS Institute as reported in the Wall Street Journal.)  Whoever holds the purse strings decides who will treat who, and how they will be treated.   The only way we will have a more rational and cost-effective approach to health care delivery, including mental health,  is through substantive reform that places emphasis on quality of care rather than productivity, and disengages special interests from the decision process.

  • Anonymous

    I learnt from “Penny Health” that Instead, try saying, “There’s medically necessary treatment that I’m seeking.” Remember, words have power and insurers are all about finding limitations and exclusions if you say the wrong thing.

  • Reality Check

    Blue Cross says the study is flawed? How is that possible? The investigators just called the clinics to get appointments and couldn’t. Welcome to reality ….

    The sad part is that I doubt this is restricted to Blue Cross/Blue Shield – they were just an example of “good” insurance. Imagine how people without good insurance fare ….

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