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Why are psychiatrists turning away patients who can’t pay cash?

Fewer and fewer psychiatrists are accepting patients who use either private insurance or Medicare rather than cash to pay for sessions. That means low-income people often can't get proper psychiatric care, a development that can have tragic consequences. Bloomberg's Shannon Pettypiece joins Hari Sreenivasan to discuss.

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  • HARI SREENIVASAN, PBS NEWSHOUR WEEKEND ANCHOR:

    A growing number of psychiatrists are no longer accepting private insurance or Medicare and preferring to accept patients who pay cash. That means many, including those at greater risk, can’t get psychiatric care, a development that can have tragic consequences.

    Shannon Pettypiece of “Bloomberg News” wrote about recently and joins us now.

    You found a very disturbing scenario of someone who had an appointment to see a doctor, ran out of meds before then, what happened?

  • SHANNON PETTYPIECE, BLOOMBERG:

    Well, basically his mother had been trying for months to get this man, who is in his 30s, who had been hearing voices, having paranoia, thinking there were drones flying overhead, the CIA was in his apartment.

    Everyone knew something was wrong. He had been hospitalized. They’ve been to the emergency room.

    But his family says they just couldn’t get him an appointment with a psychiatrist in time to keep him on the medication he needed. Either doctors didn’t take their insurance, they just wouldn’t return their calls, they had months-long wait, or they didn’t want to see him because he was a tough patient, he had history of substance abuse, he had paranoia. He was a difficult case. Doctors prefer an easier case.

    So, after all of this, you know, his mother, his friends, his family trying, they did finally get him an appointment and the medication ran out. And, unfortunately, it ended very tragically. He murdered his mother with a kitchen knife. And everybody in the aftermath was saying, how could something like this happen? How could a man with family support, in a suburb of New York City, not be able to get help?

    And one of the main reasons is because you have such a limited number of doctors willing to take the hard cases and take people with insurance.

  • HARI SREENIVASAN:

    And you abstract up from that and you talk a little bit about the cycles that are at work here. I mean, it’s not just the doctor’s fault. I mean, it’s really the supply, the demand — the whole system seems stacked against someone like this getting the care.

  • SHANNON PETTYPIECE:

    Yes, and doctors say we’re just not going to deal with it. There’s enough demand from people who will pay cash, so we’ll just, you know, focus on those patients.

    The insurance industry says, well, their job is to get the best value for their customers, which is the patient. You know, they — if they have to pay doctors more, they’re going to have to increase co-pays and premiums.

  • HARI SREENIVASAN:

    Right.

  • SHANNON PETTYPIECE:

    You know, no one wants to pay for health care these days. Everyone wants to control costs. So, the insurers say they’re trying to do what is in the best interest of their clients.

  • HARI SREENIVASAN:

    So, what are some of the, kind of, larger picture influences? I mean, how did the recession play into this? Or how did Obamacare or the Affordable Care Act play into this?

  • SHANNON PETTYPIECE:

    Well, $4 billion got cut from state mental health budgets during the recession. That’s money that goes to support community clinics that are supposed to be the safety net. And on the Obamacare front, Obamacare did try to address this issue, requiring insurers to provide mental health services, not just, you know, medical services.

    But the problem is you might have insurance but can’t find a doctor who will take your insurance. Or you might —

  • HARI SREENIVASAN:

    Because it didn’t add 1,000 new psychiatrists into the system.

  • SHANNON PETTYPIECE:

    Right. And there are some indications that the Obamacare insurance plans pay doctors even less than other private insurance plans, so doctors are even less likely to take the plans sold on the Obamacare change.

  • HARI SREENIVASAN:

    All right. Shannon Pettypiece of “Bloomberg News”, thanks so much.

  • SHANNON PETTYPIECE:

    Thank you.

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