What Is A Psychiatrist?
A psychiatrist is a medical physician who specializes in the diagnosis, treatment and prevention of mental illnesses including substance abuse and addiction. Psychiatrists are uniquely qualified to assess both the mental and physical aspects of psychological disturbance. Their medical education has given them a full working knowledge of the many causes for a patient’s feelings and symptoms. Armed with this understanding, psychiatrists can make a complete, accurate diagnosis and then recommend or provide treatment.
Warning Signs of Mental Ilness:
- Marked personality change.
- Difficulty working on the job or at school.
- Excessive anxiety.
- Prolonged feelings of sadness.
- Sexual problems.
- Insomnia, nightmares or other sleep disorder.
- Alcohol or drug abuse.
- Inability to cope with problems of daily activities.
- Violent behavior.
- Marked changes in eating or sleeping patterns.
- Chronic pain or physical symptoms not responding to medical treatment.
- Strange ideas or delusions.
- Excessive fear of people, places or events.
- Marital or family problems.
- Overwhelming stress or anxiety.
- Extreme highs or lows.
- Recurrent problems in relationships with others.
- Excessive anger, hostility.
- Intrusive or uncontrollable thoughts or behaviors.
- Suicidal thoughts or temper outbursts.
- Sense of hopelessness, despair or depression.
- Difficulties with memory, concentration or decision-making.
Friends who have had psychiatric treatment may recommend the psychiatrist who helped them. Your physician can give you the names of several psychiatrists or you can call the West Hudson Psychiatric Society at (845) 638-6992. It is very important for you or your referring physician to know about the training and qualifications of any person with whom you consult. There is an information pamphlet available from the West Hudson Psychiatric Society about the many psychiatrists in your area who have a private practice. Select two or three possible psychiatrists and phone for information about appointment availability, location and cost of the visit. Then, schedule an appointment with one.What Treatments Do Psychiatrists Use?
Today, psychiatrists ca select from many effective treatments and will work with you to create an effective program. Psychotherapy is a systematic method of treatment in which you and the psychiatrist meet at regularly scheduled intervals to discuss troubling problems and feelings. Various forms of psychotherapy can help people to change behaviors or thought patterns, explore the effect of past relationships and experiences on present behaviors or treat troubled relationships. And, because psychiatrists are medical doctors, they can also determine whether there is a need for medication to help restore imbalances in body chemistry that are often a large part of mental illnesses. Beware of any psychiatrist or other therapist who espouses one brand of treatment as the only one that works. As with any other physician, ask about the benefits and risks of the treatment program outlines by the psychiatrist.
The Initial Visit:
When you visit the psychiatrist, the doctor will ask questions about your background, family, habits and general health and will ask why you think you need treatment. The psychiatrist will want to know when you last has a complete physical examination, may ask to see your medical records and may ask you permission to consult with your personal physician. The psychiatrist knows how to interpret laboratory results and other findings of the physical examination. You should feel free to ask questions about fees, appointment flexibility, cancellation policy and insurance form processing.
When you have found a psychiatrist with whom you are comfortable, you’ve finished the first part of the treatment process. The second part – working together with your psychiatrist to understand and manage your illness – is about to begin.
YOUR MENTAL HEALTH BENEFITS & WHAT YOU SHOULD KNOW
Learn All You Can About Your Mental Health Plan
Take the time to read the section on mental health benefits in your insurance plan. This includes all the pieces of paper referred to in your enrollment form, member handbooks, newsletter and directories. If you do not understand in the plan, ask your human resources department (usually the employee benefits manager) or call your insurer directly. If you are dissatisfied with any aspect of your plan’s benefits, talk to your employee benefits manager or your union representative to try to improve your mental health benefits.
Here is a checklist for you to use to evaluate your mental health benefits coverage. In the ideal mental health plan, ALL of your answers to the following checklist would be YES.
|Are your deductibles, copay amounts, annual limits and life-time maximums the same for psychiatric disorders as they are for other illnesses such as diabetes or cancer? If not, (and you are insured through your employer’s health plan) see you employee benefits manager about getting equal coverage.|
|Does your plan cover psychiatric emergencies and will it pay for you to go to the nearest emergency facility?|
|Does your plan cover any illnesses you suffered in the past? Many plans require a waiting period for preexisting illnesses.|
|Does your plan allow you to see a psychiatrist immediately without seeing a family physician or plan service representative first? If you have trouble getting to see a psychiatrist, contact your employee benefits manager or call your insurance plan.|
|Are the brand name medications you are taking covered? If not, you can appeal. Medications are usually handled by a separate company (called a pharmacy benefit manager) that is part of your insurance plan.|
|Does your plan allow you to choose any psychiatrist you want – even one outside of your health plan’s network? (If you go outside the network, you may be required to pay a larger portion of the cost yourself.)|
|Does your plan allow you to have as many psychotherapy visits you and psychiatrist believe are necessary? Even though your plan may reimburse you for, say, 20 psychotherapy sessions a year, managed care companies may decide treatment sessions are not “medically necessary” and not reimburse you for them.|
NOTE: If your treatment includes both medication and psychotherapy, your treatment may include seeing a psychiatrist and another clinician such as a social worker. For example, the psychiatrist would make the diagnosis as well as prescribe and monitor your medications while the social worker would see you for psychotherapy or talk therapy. Because psychiatrists are medical doctors who can prescribe medications and are also psychotherapists, they can see you for both your medication visits and psychotherapy sessions. You can request that this be done.
What To Do If Your Insurer Won't Pay For Treatment:
- Use your plan’s appeal process. If you have questions about the process, call the health plan. Be sure to keep a record of the day you call, the name and title of the person you speak with and a summary of your conversation.
- If you decide to appeal in writing, be sure to:
- Document the facts that support your case.
- Keep your letter businesslike.
- Clearly state why you believe you are correct.
- Include any supporting documents from your psychiatrist.
- Save a copy of your letter(s).
- Make sure you know and meet all appeal deadlines.
- If your appeal is denied, find out if you can appeal again (many companies have three or four levels of appeal). Ask you psychiatrist to appeal on your behalf.
- Keep a record of all conversations with your psychiatrist, mental health clinician and employees of the managed care company about the matter. Include dates, names, titles, phone numbers and summaries of each conversation.
- Contact your state’s external review program.
- If all appeals fail, consider talking about your rights with an attorney, your employee benefits manager, your union representative or your congressperson. You may also wish to contact a professional organization devoted to the needs to the mentally ill, such as the National Alliance for the Mentally Ill in Arlington, Virginia or the National Mental Health Association in Alexandria, Virginia.
NOTE: If you are denied treatment in a life-threatening situation, request an “expedited appeal” from the managed care company over the telephone or go outside the system and get help immediately!
What If Your Health Plan Changes:
- Check your new health plan carefully to see if you mental health benefits are still the same. They often are not. Find out if your current psychiatrist is listed in the new plan’s network of physicians.
- If your current psychiatrist is not listed, see if your new health plan will allow you to continue seeing him or her. If not, ask your current psychiatrist to recommend a psychiatrist from the new plan’s network.
- Be sure to obtain authorization from your new health plan before seeing any psychiatrist.
Ask Your Psychiatrist About:
- All treatments that could be helpful to you, even those not covered by your mental health plan.
- Any financial arrangements your treating clinicians may have that could have an impact on your treatment plan.
Where To Register Complaints Regarding Health Insurance
The Greater New York Hospital Association (212-246-7100) has prepared a table of telephone numbers that can be used when pursuing complaints about health insurers. Please refer to the table below:
|New York State
|New York State
Department of Health
|New York State
|US Health Care
Financing Administration (HCFA)
|For complaints about...||AHIs and HSCs unless otherwise noted||HMOs and PHSPs||Any Insurer||HMOs with Medicare products|
|Prompt payment of claims and other claims issues||(800) 358-9260 any insurer||(800) 771-7755 Press 3||Mail or fax complaints to:|
|Medical necessity decisions, utilization review agents, appeal process (appeals are complaints by members and providers about medical necessity decisions).||(800) 342-3736, press 1/8/3 AHIs, HSCs and their URAs||(800) 206-8125 HMOs, PHSPs, WC/NFs and their URAs||(800) 771-7755 Press 3||HCFA/Health Plans Branch, 26 Federal Plaza, Room 3800, New York, NY 10278
Fax: (212) 264-2665
|Provider contract terms||(518) 473-4842||(800) 771-7755 Press 3||HCFA/Health Plans Branch, 26 Federal Plaza, Room 3800, New York, NY 10278
Fax: (212) 264-2665
|Member contract terms||(800) 342-3736 Press 1/8/3, any insurer||(800) 771-7755 Press 3||HCFA/Health Plans Branch, 26 Federal Plaza, Room 3800, New York, NY 10278
Fax: (212) 264-2665
|Grievance process (grievances are all complaints by members except those about medical necessity decisions), disclosure to members.||(800) 342-3736, press 1/8/3||(800) 206-8125||(800) 771-7755 Press 3||HCFA/Health Plans Branch, 26 Federal Plaza, Room 3800, New York, NY 10278
Fax: (212) 264-2665
|Quality of care||(800) 206-8125||(800) 771-7755 Press 3||(800) 331 7767 (IPRO)|
|Insurance fraud||(888) 372-8369|
|AHI = Accident and Health Insurer regulated under Insurance Law Articles 32 and 42.
HMO = Health Maintenance Organization certified under Public Health law Article 44.
HSC = Medical/dental indemnity or hospital/health services corporation licensed under Insurance Law Article 43.
PHSP = Pre-Paid Health Services Plan certified under Public Health Law Article 44.
URA = Utilization Review Agent required to register with the Department of Health under Public Health Law Article 49 or Utilization Review Agent required to report to the Insurance Department under Insurance Law Article 49.
WC/NF = Workers Compensation or No-Fault insurer.