“I was referring them, but they didn’t have access to any mental health providers,” Dr. Zhu said. One of her patients said she called more than a dozen providers before taking her appointment.
Insurers say their goal is to provide a wide range of mental health services. “Everyone deserves effective, affordable and equitable mental health support,” Christine Grow, spokeswoman for AHIP, a trade group representing insurance companies, said in an email.
But Ms. Grow noted that the Health Issues Study did not compare the plan to traditional Medicare, nor did it explore other types of mental health services available to patients through other clinicians or telemedicine. criticized. “Essentially, this study uses a very narrow definition of a mental health physician to prove existing theories about Medicare Advantage,” she said.
More broadly, regulators and legislators have expressed concern that private Medicare plan participants may not receive the services they receive under federal programs. Critics have long complained of poor access to mental health services.
Oregon Democratic Senator Ron Wyden, who heads the Senate Finance Committee, said: public hearing In May, I described a so-called “ghost network” of mental health providers, where many of the clinicians on the Medicare Advantage program’s roster don’t actually take patients. His staff secretly conducted shopper surveys, but he only got 18% of reservations.
Zhu said the health problems survey may have exaggerated the availability of psychiatrists because it only looked at health care providers on the plan’s roster. “It probably paints a rosy picture,” she said.
Dr. Robert Trestman, president of the Council on Health Care and Financing for the American People, said the low payouts from insurance companies and all the paperwork required meant that physicians opted for the Medicare Advantage plan. He said he may not want to participate. He testified before the Psychiatric Association and Senate hearings. “Many of the challenges and frustrations are highlighted in the Medicare Advantage plan,” he said.
Researchers say some insurers pay psychiatrists less under Medicare Advantage plans than traditional Medicare pays for the same services. Researchers said the plan could also include incentives to contract with a smaller group of doctors for more control over the costs and treatments provided.