Thanks, Elle. It's easy to gripe about what insurance covers and assume the government can/will/does/or even will do any better, but think it makes sense to understand if that's even true. Medicaid isn't disability insurance; it's state funded social welfare insurance for the poor and controlled under guidelines of the federal government, though do understand some people may have both if both, and social welfare programs can vary from state to state. Though okay fair enough, it can be different, and let's include poor people on state assisted programs. Do government/state welfare assisted programs provide more financial coverage than typical health insurance limitations of once per month? Even sometimes? Even considering someone with the best government/state coverage combined? Was reading trying to find an answer myself, though was only specifically looking at federal disability Medicare and not state funded programs. Had no clue it was so bad. Current legislation has made a lot of improvements, and though it clearly stated there are limitations on federal health care for mental care; can't seem to find it stated anywhere what those limitations are. Up until this year, mental health care for the disabled was probably the most grossly underfunded area of federal assistance, covering as low as 40% of costs and no coverage of pharmaceuticals until laws were changed in 2008, requiring annual increases beginning in 2010 until reaching 80% coverage in 2014; though inpatient care is still scarce and meds are very picky. Read that the new legislation is so important because the majority of mental health professionals wont even accept patients with Medicare. So going to stick to my guns of the government needing to fix their own healthcare problems first for the elderly, poor, and disabled. Though your input into this conversation makes me want to know if people with federal coverage, or even state coverage, are provided coverage for more services than someone else with a typical health insurance policy.
Jack, I think I'm struggling with your question because it seems either too simplistic, or too broad.
Here are some things I can say which might get at what you're trying to ask.
Different insurance companies do PAY doctors different rates for the same services. They will also pay different amounts- copays, coinsurances, or deductibles may fall to the client. Some medicaid plans are actually free, while some have cost, but cost less than buying private insurance on your own, rather than having it provided by a company. I believe with medi*caid,* the lower your income, the more likely it is you'll have lower- or no- copays, in general, but I get the impression that isn't consistent and it can vary based on type of service, or type of prescription. Medicare has several potential "parts," and, without actually doing research, I'll say anecdotally I get the impression it doesn't fully cover things it really ought to, and having medicaid supplement it can help pick up some slack.
Summary of above paragraph: It's
complicated.
Different insurance companies
require different things of the exact same providers of the exact same services. Sometimes doctors don't "accept" masshealth clients not because masshealth is a lousy payor, but because private insurance companies don't have the same kinds of burdens in terms of administrative hoop-jumping to be licensed as a provider. (I could bitch about this one for hours but that's the quick version).
re: the issue of how many visits clients will "get" with me: It's largely at my discretion, regardless of insurance. And regardless of disability.
Further explanation of this: M&M allows infinite visits, and they will periodically audit the company to make sure they're getting what they're paying for (rather than ask us to prove to them that we need more units). The various masshealth payors have their own systems of having us ask them for units (different web sites, which they periodically tweak)- they all start off with 12 units automatically auth'ed, and we ask for more as we need them, which is not a big deal and is a part of the job (albeit one of the many unpaid parts, of course). Typically that is us providing relevant clinical information to make the case for how often we want to see certain clients, and why. This will be granted based on level of symptomatology, not on disability status. Private insurance companies usually seem more lax; those clients usually don't meet "medical necessity" to be seen weekly (that's clients who are more high-risk/high-need, typically), but, again, we can plead the case (fill out paper forms, usually). And even some private insurances seem to automatically authorize what effectively end up being infinite visits. They usually will start with 12 or 24 units before needing another auth, but the 12 units thing isn't an absolute. The insurance company will just need to have a
reason to give more units after that.
