[batrachos]

> The insurance company doesn't know what you are discussing in your sessions

That's not true. From what I understand, sessions are coded e.g. "Intake" or "Meds check" when billed to insurance. They know roughly what you're talking about.

> and isn't going to let you see or not see a specialist just based on whether they prescribe you meds.

You can't bill a meds check with no meds.

> That's not how it works - or not how it should be working if your insurer is acting appropriately. I also saw this psychiatrist a couple of times before taking anything. I didn't walk out of my first session with a prescription for buspirone.

And those sessions were probably billed as "intake", "evaluation" or the like. A psychiatrist cannot keep billing intakes and evaluations forever. Talk therapy is coded in its own way, and generally paid at a lower rate.

[ivraatiems]

> That's not true. From what I understand, sessions are coded e.g. "Intake" or "Meds check" when billed to insurance. They know roughly what you're talking about.

You are correct that CPT codes give some insight into what was provided, but you are wrong about what codes providers use in this case.

To check myself, I pulled my insurance provider's EOBs for my last two visit to a psychiatrist and my last visit to a psychotherapist. The codes were as follows:

Psychiatrist - CPT 99214 and 90833. Those are "office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a detailed history, a detailed examination and medical decision making of moderate complexity", and "Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 30 minutes" respectively.

So I don't think from these you can assume "this person was prescribed meds", necessarily. These are very similar to a standard doctor's visit billing code, or a therapy billing code (as below).

Psychologist - CPT 90837, which is "60 Minute Individual Therapy"

Both of these EOBs indicate the insurance paid the provider for the codes as billed. This is one example, but I'd be surprised to find it wasn't representative (that is, that my providers are not billing in generally accepted ways).

> You can't bill a meds check with no meds.

As you can see above, there isn't necessarily such a thing as a "meds check" CPT code. The codes don't give the kind of information you're imagining.

> And those sessions were probably billed as "intake", "evaluation" or the like. A psychiatrist cannot keep billing intakes and evaluations forever. Talk therapy is coded in its own way, and generally paid at a lower rate.

It is true talk therapy is a separate CPT code; it isn't true that it's always paid at a lower rate. The negotiated rate depends on the insurance company and provider's agreement.

[staticman2]

Talk therapy where I am pays 75 dollars for 50 minute session on my insurance.

Someone who has been through med school would not typically lower themself to that rate, nor do I buy the idea that some insurers are inexplicably more generous and pay doctor rates for non doctor work.

Remember, talk therapy does not require as much education, you do not need a phd or md to do it. An MD would not get doctor level payouts doing talk therapy.

[ivraatiems]

It's true an LISW or similar wouldn't make the same rated as a PhD or an MD... but between the same "tier" of education in the provider, rates are surprisingly more comparable.

Insurers aren't more generous - they have negotiated rates. They're never paying 100% of what's charged. Some providers are better at negotiating, or have more leverage, than others.

[staticman2]

You don't have to believe me when I say psychiatrists don't tend to do things not involving drugs, you can read this quora thread:

https://www.quora.com/Why-don-t-psychiatrists-do-talk-therap...

You've shared a belief that a patient will continue to see a psychiatrist when not being given drugs. Since psychiatrists don't tend to do talk therapy, I will reiterate I don't believe this is correct.

I'm sure there are exceptions- a wealthy person might find a Doctor Frasier Crane type Doctor to do talk therapy- but they would be paying out of pocket. I know the local Ivy League school only takes a special Ivy League insurance offered only to the Ivy league school's students and staff. The wealthy- and their Doctors- don't need to worry about the "rules" set by insurance companies.