Insurance & Other Payers | William Thorneloe, M.D.
Insurance and Third Party Payers
American Healthcare has been dysfunctional for most of our lives. Schemes to pay for quality healthcare have quickly become schemes to increase corporate profits for a number of businesses. Patient centric care has become rare, as more insurance companies have found better profit in denying care and access to treatments.
I have attempted to provide my services helping patients use insurances. Patients should have a good expectation that their premiums will help them in times of trouble – not have these policies add to their problems. Patients have little to no idea of how third party payers price their reimbursement rates with a variety of rates and codes for care. This has led to many unpleasant surprises for patients and physicians when high deductibles and low reimbursement rates are experienced.
I have begun limiting my participation with insurance companies for a number of reasons. Previously, I stopped accepting UnitedHealthcare. In 2021 I have taken steps to sever ties with BCBS/Anthem, Cigna, Humana and Wellcare. I have never participated in Kaiser or other HMO products.
Currently, I accept assignments with Medicare, Aetna, ComPsych and a few other companies. I do not accept new Medicaid patients due to the very low reimbursement rates and limitations on care by Georgia Medicaid. Medicare Advantage plans may or may not reimburse for my services even though I participate with Medicare. In general, I have found plain Medicare to be better for patients and physicians.
I understand the difficulties this places on patients seeking psychiatric services. I will continue to file insurance for patients, but will not accept assignment for the companies I have ceased contracting. This will allow patients to be directly reimbursed by these companies and have benefit of out of pocket maximums.
Payment is expected at the time of services. Credit cards must be on file or other arrangements made. I will discount cash/check/credit card payments at substantial rates.
If this is not acceptable to my current patients, I will assist with getting records to other practitioners who still accept these insurers.