Many patients who first call my office have never considered looking outside of their insurance network to find a psychiatrist. Many patients assume it will be easier and less expensive to see an in-network psychiatrist, but quickly learned that’s often not the case. It can be very hard to find an in-network psychiatrist in Los Angeles, especially near Santa Monica, who accepts insurance, is taking new patients, responds to phone calls and does not have an extremely long waitlist.
If you’re looking for a psychiatrist and deciding if you want to look for one in or out-of-network, here are some reasons you may want to consider not limiting your search to your insurance network.
6 Reasons to see an Out-of-network Psychiatrist
While many psychiatrists are qualified to treat common challenges such as anxiety or depression, if you are interested in working with a specialist to address a specific challenge, you should consider looking out-of-network. Private pay psychiatrists often have additional fellowship training and board certifications. For example, I am addiction psychiatry fellowship trained and am double board certified in general and addiction psychiatry. If you come across a psychiatrist whose skills speaks directly to your needs — perhaps needs you didn’t even know to look for — it’s worth reaching out.
I specialize in the evaluation and treatment of both mental health and addiction related issues. This makes me a bit more conservative, maximizing one medication before adding in others, aiming for the lowest effective doses of medications and trying non-addictive and non-habit-forming medications first.
If a psychiatrist isn’t constrained by only providing services they can bill to an insurance company, they are often able to spend more time and individually create the perfect treatment plan for you. They can offer longer or more frequent sessions than insurance might cover. This may allow you to feel more comfortable, less rushed and able to have all of your questions and concerns addressed.
I provide medication management and basic supportive and psychoeducational psychotherapy for my patients, which allows for a more comprehensive understanding of your mental health needs before prescribing. I am also able to take the time to speak to your therapist or other members of your treatment team. These services require private pay, but they offer great convenience and highly coordinated care.
A deductible is the amount you have to pay upfront before your insurance coverage kicks in. If you have a $5,000 deductible and you haven’t had any other medical expenses yet in the year, you are responsible for paying up to $5,000 in fees out-of-pocket before your standard copay applies.
On the other hand, if you have good out-of-network benefits, your insurance company may reimburse you as much as 80% of each session fee, depending on your plan and cost of the appointments. This means that in some situations, using your out-of-network benefits can actually be very comparable to your standard copay to see an in-network psychiatrist.
If you want full discretion, or otherwise do not want your insurance company knowing you are seeing a psychiatrist, you might consider paying out-of-pocket for greater privacy. In order for your insurance to pay for therapy sessions, psychiatrists are required to provide the company information regarding your sessions, including a diagnostic code. If you don’t want your insurance company to have access to any information about your mental health, consider out-of-network options.
In cities such as Los Angeles (especially on the westside) many psychiatrists choose not to accept insurances, and those who do tend be extremely full. For many patients trying to use their insurance, it can very difficult to find a psychiatrist who is in-network and accepting new patients. If you limit your search by insurance, you may have to spend months on a waitlist before seeing a doctor.
Private pay psychiatrists, like myself, tend to have more availability and greater flexibility in scheduling new clients. In some cases, I will help a new patient get stabilized over three or four office visits. Later on, if cost becomes prohibitive, I can help transfer them to an in-network psychiatrist to continue their care once they are already doing well.
At the end of the day, your relationship with your psychiatrist is one of the most important aspects of the healing process. If you only consider in-network options, you might eliminate a psychiatrist who would be a really good fit for you and maybe help you feel better faster.
Choosing an in-network psychiatrist who doesn’t make you feel comfortable, feels rushed or unavailable or does not specialize in the areas you’re struggling with solely because they’re in-network is a waste of time and money. I recommend prioritizing the fit and you’ll find a great match.
Being able to speak to the psychiatrist for a free phone consultation can be both a good assessment of their availability (i.e. how long does it take to them to call you back?) and also to see if you feel comfortable enough to schedule an in office initial appointment. I offer a brief free phone consultation for all new prospective patients (often as soon as same day or the next day).
If you are working with a psychiatrist you really like and they retire or your insurance company changes or you move (you graduate school, you switch jobs etc.), don’t panic! Depending on your insurance plan, it may still be affordable to see a great new psychiatrist using out-of-network benefits.
To learn about how to utilize your out of network benifits, find out if you have them and more, read more here.
On the Web: docgoldenberg.com
The Huffington Post Articles: https://www.huffingtonpost.com/author/mattgoldenberg-950
*Matthew Goldenberg D.O. is an addiction psychiatrist, board certified in General and Addiction Psychiatry and is a mental health and addiction expert. He maintains a private psychiatry practice in Santa Monica, California.
The conditions Dr. Goldenberg treats include depression, (major depressive disorder, MDD), bipolar disorder (mania and hypomania, aka bipolar depression), anxiety disorders (such as panic disorder and panic attacks; obsessive compulsive disorder, OCD; Posttraumatic Stress Disorder, PTSD); Attention Deficit Hyperactivity Disorder, ADHD; insomnia and sleep problems; addiction (alcoholism, drug addiction aka substance abuse and substance dependence); behavioral addictions aka process addiction (food addiction, gambling addiction sex addiction etc).