Cincinnati, OH–Two prominent Cincinnati psychologists have publicly announced that they will no longer do business with HMOs. Actually, an eight-column headline in the Cincinnati Enquirer recently carried the issue a step further, announcing the two had “fired” HMOs from their practice operations.
Jill Bley, Ph.D. has long specialized in treating people with sexual disorders, and her particular prominence stems from writing a column in the Downtowner, a newspaper that circulates to 40,000 residents and stores in and near downtown.
William Wester, Ed.D., a longtime practitioner, has conducted workshops on hypnosis nationwide. He is chief executive of the Behavioral Science Center in Cincinnati. He was among the earliest members of the state’s psychology licensing board.
Wester was also a pioneer who sensed the impending changes in the healthcare system and first incorporated his practice in 1981 when he switched from solo to group practice in response to demand by the early managed care companies. A half dozen other practitioners in Ohio embarked on similar paths about 1985 in an attempt to position themselves more advantageously in the changing healthcare arena. During those early years, Wester’s practice grew to 32 psychologists and he recalled that managed care became interested in his operation because it was such a large group, and fit their modus operandus for contractual relationships.
For some years thereafter, Wester’s practice flourished in volume with referrals from managed care contracts. But as managed care shifted, dropping fees substantially, reducing allowed sessions and increasing paperwork, Wester said he became frustrated. “It made practice increasingly difficult,” he explained.
“Earlier this year, I had one HMO telling me what to do and not to do with a suicidal patient,” Wester was quoted. “I asked them, ‘Are you willing to assume the risk, like I have to, if something goes wrong?'”
Bley was quoted that payment denials and delays become too cumbersome. She said she has about $60,000 in unpaid claims locked up in coverage disputes that occurred after services were provided.
Beginning Sept. 1, Bley and Wester, who happen to be located in the same city but whose practices are not affiliated with one another, plan a “cash practice.” Both said they believe they will be able to retain most of their clients. They hope to eliminate overhead costs which stem from dealing with insurance companies.
In a letter, Bley and Wester informed their respective clients of the impending change. Wester told clients he will charge $110 per hour, minus 20% for those who pay at the time of service. Bley plans to charge $85 per session, with payment up front, but she said she expects to help clients work out-of-network reimbursement approaches.
Responding to news of Bley’s and Wester’s plan, Ellen Shuman, who directs the Acoria Eating Disorders Treatment Center in Cincinnati, bemoaned that with fewer people using insurance, fewer people getting treatment, insurance companies keep more and more money.”