Letters to the Editor

Psychiatrists committed to excellent care, not insurance companies

As a practicing psychiatrist, I really want to express the other point of view in response to Gardiner Harris’ article “Talking therapy declines” in the 3/6/11 Cincinnati Enquirer. While it is true that many psychiatrists have capitulated to pressure from insurance companies, patients should never give up on finding a psychiatrist that are, instead, committed to treating the whole human. Since insurance companies are all designed to make the most money possible by paying out the least possible reimbursements, why would any doctor have the preferences of insurance companies be their main guide in how to practice medicine? Insurances companies might be one of many influences on how physicians practice, but should never be the preeminent one.

Since I’ve taught residents at the University of Cincinnati Department of Psychiatry every year since 1980, I know most of the psychiatrists in Cincinnati. There is a growing minority of psychiatrists that practice like the doctor described by the article, but the majority still provide whatever combination of talking therapy and medication that would best serve the patient. Sure, they could make more money if they ran all patients through a mill in 15 minute appointments, but most psychiatrists went into that specialty because they want to work with patients, not run them through an impersonal system.

Since I’m committed to providing whatever combination of talking therapy and medication the patient needs, I’ve gradually dropped off all insurance panels. This means that patients can still get some benefit from PPO but not HMO insurance, but the insurance will pay less than if the patient saw a psychiatrist who is “in panel.” But every psychiatrist who is “in panel” has signed a contract with the insurance company to practice medicine the way the insurance company dictates. Do you want to receive your mental health care from an health care professional or an MBA? So my patients and I negotiate a fee that is workable for both of us.

About half the patients I see first selected a psychiatrist from within their insurance panel, were discouraged by the short shrift care they got by following insurance company rules, then came to someone who is committed to excellent care rather than enslavement to insurance companies. How do patients find this kind of psychiatrist to stay away from ones like Mr. Gardiner describes? By doing their homework: they should ask their primary care doctor, specialists, minister, teachers, etc. about who is committed to doing it right until they find a really good one.

Noel Free, M.D.


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