As always, you can leave comments asking me anything including about what I bring up. But remember, I'm not the be-all end-all on this topic. Even if I think I am.
So what's up with Obama-care, affordable care, whatever?
Well, that's hard to say. I know what the new healthcare is supposed to be; affordable healthcare for everyone and whatnot. But I work primarily with people who are on Medicaid which is state funded health care. Now I'm no expert on how exactly this system works but I know enough for my job and just enough to be dangerous. Here's my take on Medicaid generally speaking; it is affordable health care. From what I understand the new healthcare is supposed to be more all encompassing and cheaper but a lot of my client's get the Medicaid for free so you can't get much cheaper then that. So, basically, the new healthcare seems more all-encompassing. I think.
Ok. But, we still don't know how it'll work in real, paying agencies terms. As far as I know no one in my clinic, including our financial people, have heard how it works. We don't really know anything really about how it is supposed to pay us. As it stands now all of our established and new clients have Medicaid, or 'other' insurance (we'll discuss that in a second), and still do. But we also heard that the new healthcare will either change or be an adjunct to medicaid. But we don't know how that really works either just that something is going to happen at some point. So we are taking on clients and keeping clients and doing therapy work without knowing if next week or month or whatever we'll have to let them go because they don't have benefits or their benefits don't cover our therapy. For that fact, we don't know how much the new healthcare will cover our sessions (basically how much money do we get in return for services rendered) or even if our services will be covered. Or if chemical dependency will be covered. We don't really know anything! Which makes this whole change real frustrating to plan for both financially and therapeutically. Do we prepare client's for ending sessions? Do we handle things as if nothing will change because, for our purposes, they won't? WHO KNOWS!
Wait, paid for services rendered?
Yep. We get paid for our work. And how much we get paid depends on things like insurance. So I work for an agency that is non-profit and serves more lower-income individuals. In our circumstance, we get paid the most from medicaid insurance. Private insurance is next (which will cover in a second). Then medicare if it is covered by our agency (I'll cover that later too). Then sliding fee scale which is waaaaaay less then medicaid. Basically, the lowest end on our sliding fee scare results in about 10% money back of what we get from medicaid. So as a businesses, even a non-profit businesses, need to keep things like payroll, budget, etc. on the mind. We have financial goals we have to keep to stay open. So we can only take so much medicare, private pay, and sliding fee scale. Which is an issue because we may have to implement things like a wait-list that can last for months on end. There are more too. Keep reading.
So lets pretend the new healthcare system doesn't exist. Which insurance is better; medicaid, medicare, or private insurance?
Well, all have their benefits and drawbacks. Medicare is the exception really for mental healthcare. There are types of medicare that cover counseling and more that cover psychiatry. But those types of medicare are rare. So we have very few medicare clients.
Medicaid pays kid. It pays us well. So we like medicaid. Plus there are systems in place where I live that makes getting into services when you have medicaid pretty simple. Which I think is pretty cool. With medicaid there's no fuss, no muss, no legwork. Here's the drawback; as you improve, if your getting medicaid for free, you'll lose that medicaid. Basically, medicaid is conceived as a way to help people to better themselves when they are low so they can improve, rejoin the workforce, and live productive and happy lives. Then medicaid benefits go away (which not only cover mental health but dental, medical, eye-care, etc.). Most jobs these clients would get would be low paying and wouldn't have insurance (which hopefully the new healthcare system would fix). So clients are conditioned to be unhealthy to have more. It makes therapy really frustrating sometimes because you're helping someone so they can improve and consequently have less in the hopes that way later they'll have more. It's a hard arrangement.
Private insurance is nice because there's freedom. Client's dictate their insurance fully as long as they pay. Pay more and you get more. It's like other insurances. Pay more for car insurance you get better coverage. Same thing with medical, mental health, dental, etc. insurance. It is also there for you when you get better (you know, as long as you keep paying for it). The drawback is that you have to do leg work.
Here's how it works. Clients call their insurance companies and they give clients a list of providers. Some of these providers are in private practice and some are in agencies. Private providers are nice because there are only the providers to deal with and no politics (for lack of a better term). The problem being they only have so many hours to fill with sessions and can only take so many clients. An agency has a ton of therapists with all sorts of hours to be filled with therapy sessions. Unless their are full with clients (which happens).
The problem with agencies is that, for private insurance, likely only a few therapists are on the boards of a few insurance companies and they need to be on the board of those companies to be reimbursed for services rendered. But then you have to make sure those therapists have free slots for clients. Or that the agencies can be paid for their services by the private insurance (which isn't a ton) while still meeting their budget. It's all a lot of work for everyone.
It all sounds confusing and frustrating.
So the new healthcare will fix it?
Cross your fingers. I have a feeling though that it'll be nearly exactly the same with just different, new headaches to deal with. Call me a cynic I guess.
That's it for this blog. Ask away dudes. And correct me if I'm wrong because there's a good change I might be in some of this information. It's all very complicated.