What Medicare Reimburses for Mental Health Services

Written on:March 23, 2008
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In 2008, when you see a psychologist or psychiatrist for a first-time evaluation, Medicare reimburses them approximately $142. I say approximately because this varies by region of the country. For example, if you live in Mississippi, your doctor gets about $139. If you live in Manhattan, your doctor gets about $169. Does this start to give you an idea why some of parts the country may be better served than others?

By the way, the variation in rates does not have anything to do with how many doctors there may be in a given region. Does anyone believe Mississippi is less saturated with psychiatrists than Manhattan? You would think that a rational policy for setting rates would vary them in order to draw more doctors to places there are shortages.

If you see your psychologist for 45-50 minutes for a therapy session, Medicare reimburses the doctor $84.74. This is for Wisconsin, as are all of the following numbers, a nice heartland state. Actual prices will vary somewhat in your region. Here are some others.

Typical Medicare Mental Health Reimbursement

First evaluation visit with psychiatrist or psychologist $142.03
Therapy visit, 20-30 minutes, psychiatrist or psychologist $59.65
Therapy visit, psychiatrist or psycyhologist, 45-50 minutes $84.74
Therapy visit, medical practitioner, 45-50 minutes with "medical evaluation and management" $93.45
Medication checkup $50.31
Psychological testing $81.11

If you are interested, you can search yourself how much Medicare reimburses for a procedure. For example, if your psychologist recommends you have psychological testing, ask your doctor to give you the “CPT Code” — that is the “Current Procedural Terminology” code by which all medical procedures are identified. Then go to CPT Lookup and search with the code number in your locale to see what the Medicare reimbursement is.

Then, go to the web site for your insurance company. Look for the reimbursement values for the procedure you are going to have with your doctor, and compare it with Medicare.

You won’t be able to find it. Your insurance company considers how much it pays its doctors “propietary” and will not make this information public. If your doctor does not have a contract with your insurance company they may not even tell your doctor how much she may receive for the service she is about to provide. Indeed, unless you are very persistent, you may not be able to obtain the information from your insurance company.

Can you imagine any other business in which the person providing the service does not know how much they will receive? Or the person purchasing the service may not know how much their responsibility will be?

This is classic of the secrecy of for-profit insurance companies.

This also one of the many ways a “single payer” health care financing system — and Medicare specifically — is far superior to a for-profit insurance company. Medicare reveals its reimbursement rates quite publicly. For-profit companies consider this information a “trade secret,” and claim they cannot reveal the information or it would undermine their ability to do business. Of course that’s a load of crap.

  • You, the patient absolutely deserve to know how much your insurance company is paying your doctor. At the very least it directly affects how much of a co-payment you may have. However, unless I have a contract with your insurance company, as your doctor I am never able to get this information from your insurance company until after they have (or haven’t) paid your first bill.
  • If you watch this over time it will give you an idea about what is happening to doctors’ rates. One of the biggest lies the for-profit health insurance industry tells is that one of the main reasons for skyrocketing health care costs is because doctors are charging increasingly big fees.

This is a lie because (1) in today’s world doctors do not control how much they get paid, insurance companies do.

This is a lie because (2) if you look at actual reimbursement for doctors’ fees you will see that there has been a constant downward pressure, and that this has happened for years.

It has been clearly shown that the greatest downward pressure on all fees has been in mental health fees. For example, a well-known study found, “The total value of employer provided health care benefits, in constant dollars, decreased by 14.2 percent over the last eleven years. The value of general health care benefits decreased by 11.5 percent since 1988, while the value of behavioral health care benefits decreased by 54.7 percent. As a proportion of the total health care costs, behavioral health care benefits decreased from 6.1 percent in 1988 to 3.2 percent in 1998.”

Why the decrease, and why especially in mental health benefits? Because insurance companies control what doctors make, not the doctors. Because for-profit insurance companies are trying to do what they were designed to do: make as much profit as they can.  (And you thought they were in the business of insuring your health care coverage!?) Because insurance companies think they can do this by taking advantage of people who are the least ready to fight back: people who seek mental health care.

So, if you would like some interesting education and can stand just a little bit of frustration, go to your insurance company’s web site and try to find how much they will pay your doctor for the work you are about to have done, or for the services you had last year. Then, when you can’t find it, actually give them a call and see what they say.

Then, if you happen to be persistent and actually get the information from them, compare your company’s reimbursement to Medicare.

And when you’re done, please come back here and tell us here what you find out! Let us know what your insurance company is reimbursing your doctor for mental health care. Let us know if it’s more or less than Medicare.

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