Insurance: The Good, The Bad, and The Ugly.

providercentral-logoFirst, “The Good.” As of today, I am now a provider in the Blue Cross Blue Shield network of Massachusetts. I am on the preferred provider network (PPO), the HMO Blue (managed care) and the Indemnity list. If you are a Blue Cross member in Massachusetts, I am taking new clients and would be glad to speak with you about an appointment.

“The Bad” I opened my private practice here in January and it has taken this long to complete the credentialing process with  BCBS. They have actually come in ahead of schedule as the process can take 90 days. I am still waiting to complete the process with Beacon Health and Tufts. It should not be much longer for either of these networks. So, stay tuned.

Finally, “The Ugly” I completed grad school in 1995, was licensed in 1998, have years of additional training and experiences and even teach at the graduate level in my field. However, providers such as United Behavioral Health (Harvard Pilgrim) and Aetna have denied me access to their panels as a preferred provider. “Why, what did you do?” someone might ask. I have never had a complaint of any sort…not the smallest blight on my record. In fact, I have hundreds of satisfied clients from my two decades of practice. The reason insurance companies drag their feet or completely deny access to new providers is that it would cost them money. Currently, I work with a client who has Harvard Pilgrim and I file the insurance as an out of network provider. Either my client eats the extra expense or I do. In this case, I choose to accept the reduced fee.

When insurance companies deny access to new providers they are actually denying access to the people they serve. By disallowing new providers there is a smaller pool of providers from which the client may choose. Now the client (you) has to call current contracted providers and make an appointment for which you have to wait weeks or months or you can call an out of network provider like me and be seen within days but pay a higher fee or I must accept a reduced rate.

So, that is the math behind it all. That is why you may have to wait to see a provider of any health care service. Often, it has nothing to do with whether a qualified provider is nearby and has available appointments and has everything to do with how much your insurance company is willing to pay out even though they are increasing your fees all the time. Just thought you would like to know.

Author: Eric Greer, MS LMFT

I'm a licensed marriage and family therapist and have been practicing since 1995. I am the sole owner of Restoration Community Counseling in Kingston, MA. My primary areas of practice include couples, post-traumatic stress, anxiety, depression, and veteran's issues.

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