Let me set the scene: this is a letter from a pediatric practice with both a child psychiatrist and a psychiatric NP (great start to a story!). A large, gorilla payer subcontracts its mental health care to another well-known “healthcare management company” who presents a no-negotiation contract significantly below Medicaid rates.
The practice has little choice but to not contract with the payer at all. But the parents who desperately need these services don’t fully understand the machinations of these relationships and seek guidance from the practice.
The practice thus crafted this letter below to share with the parents to explain their position. Read it carefully…
This letter is to explain why we have been unable to join the [Payer] network and why you will have to pay out of pocket if you wish to see our excellent child psychiatrist, Dr X or psychiatric Nurse Practitioner Y. Your insurer has unfortunately decided to subcontract all claims for mental health to the [Payer] network and we have been unable to come to an agreement with them.
Despite the fact child and teenager mental health is desperately needed in our local area, [Payer] presented us with a “no-negotiation” contract that pays significantly below Medicaid rates on the vast majority of the care Dr X provides. In light of the desperate needs for mental health care in our counties, we were stunned by their refusal to explore possible solutions. We have had families drive north of [a city far away] for child psychiatry!
[Pediatric Office] is unable to subsidize mental health care to patients insured by such a profitable corporation. Just for reference, [Payer] (NASDAQ: [Payer Stock Index Code]) had net revenue of XX billion and net income of XXX million for the year ended 12/31/2013. Our position is that is makes sense for them to pay the same reasonable amount above Medicaid for mental healthcare as our other private insurance companies do for medical care.
[Payer] news releases<[web references bragging about their profitability]>
It is likely that your employer does not realize that they have been paying for insurance that does not cover the costs of this needed care in our counties. If you are interested in creating change, please tell your human resources department that you wish that your health insurance provided coverage for the excellent mental health care available at [Pediatric Office]. We will be glad to discuss with them if they need further details.
In the interim, please discuss with our business office representatives what financial arrangements we can make with you so that your child can get the care they need.
It is difficult to convey how frustrating this experience is for us as well- we really do want to provide the best care possible for your child and that is why we have been forced into this action!
I love this letter! References to the payer’s stock value! Profit highlights! The bottom line is that it’s all about the money, so let’s get the cards on the table. Steal this idea.
I also like that the letter gives very specific direction to the families about what they should do as a result of this challenge.