View Full Version : Finding new psychiatrist after insurance change


brendanv005
11-27-16, 11:12 PM
Hello all,

First some background: I was diagnosed with ADHD back in 2005 and have stably been prescribed Adderall (currently 15mg XR + 10 mg boost) for years now. I tried other medications, but this what has worked and do not want to rock the boat right now. I am on a HealthExchange plan from the Federal Marketplace with UnitedHealthcare. Anyways UnitedHealthcare is dropping all Exchange plans and I need to switch to one of 2 other insurance companies (UPMC and Highmark). My nurse practitioner insists that they take both of them. UPMC is the cheapest option but I can't get them to confirm and I'm suspicious (sometimes there may differences between commercial plans and healthcareexchange/marketplance plans).


Anyways, I think I might need to find a new psychiatrist for medication maintenance due to this possible conundrum. That and it would help with work to not have to go in for an in person appointment every month instead of giving me 3 months of scripts like this one does.

My main question, has anyone been forced to change doctors for insurance reason multiple times like I have and then have difficulties discerning who is a private psychiatrists. I call the different numbers and they always want you to see their therapist first. I don't have a problem with that, its just that in this area they say "Well you have to see them for so many sessions" before/during you can see the doctor." Every practice has their policies but my situation has happened several times and it is grueling to go through this process. It seems like an exercise just to make money on their part.

I am looking for a good way to find/screen what are the right private psychiatrists who I can transfer treatment in the Pittsburgh area. I have to be proactive because I don't want to suddenly find myself paying out of pocket costs with the doctor to continue treatment. Anyone know of a good resource for this?

ToneTone
11-28-16, 12:12 AM
So who is the nurse practitioner? ... She's not your provider? ... I happen to go to a psychiatric nurse practitioner ... and the reason I do is relevant to your situation. (And I'm in Philly!) ...

Anyway, I have a really good insurance plan through work ... pay a lot for it ... and I could not find a psychiatrist in network ... And I got very lucky ...

So basically, none of the folks in network who work alone were taking new clients ... I mean I called dozens ... couldn't get a response, etc ... Most said they weren't taking any new patients ... Insurance reimbursement must be really low for in-network psychiatrists ... I was stunned ...

And yes, any practice that has a psychiatrist as part of it ... does exactly what you're being told ... they require you to be seeing their therapist if you want to see their psychiatrist .... So you're looking for an independent psychiatrist, if you will ....

After dozens of calls, I finally found a psychiatrist in nearby south New Jersey who skyped ... from California ... I had to go to the office in Jersey ... and insurance covered the visits. (The rule at least in Jersey was that I had to go to a doctor's office for the skyping--his office manager was there.) But this psychiatrist seemed really close to retirement (that's why he was away) ... and he wanted to meet once a month ... and on weekends!

I got the idea of searching for a nurse practitioner and that's what I ultimately went with ...A psychiatric nurse practitioner to be exact ....Psychiatric nurse practitioners can write prescriptions and they seemed to be accepting new patients, and a number of them worked alone (no see-their-therapist requirement). Mine works in a public facility but takes private clients one day a week. She gives me more time than the skyping psychiatrist did, and she's good ... and she's in network ... I meet with her every three months usually. This time, I switched meds, so we're meeting after 6 weeks ... but once we adjust the med a few times, then the appointments will be spread out ...

So I say keep making calls ... literally go down the list ... of people who say they're in the new network ...

Two consider psychiatric nurse practitioners ... They generally seemed to accept various insurance plans ... I guess their salary expectations aren't the same as psychiatrists'!

My family doctor will prescribe when I'm between providers ... but she doesn't want to be the regular prescription writer. You might ask your family doctor/nurse practitioner to tide you over.

Anyway, I feel your pain ... I totally feel it ... The only consolation I can give you that at least in the Philadelphia area, even if you had the best of insurance, outside the exchange, finding a psychiatrist in network is nearly impossible.

Good luck. Shoot me a pm if you want to talk more about this ...

Tone