Wednesday, June 14, 2023

Survey Reveals Stark Difficulty in Obtaining Appointments With Child Psychiatrists

Calls to hundreds of child psychiatrists listed as in-network with Blue Cross–Blue Shield (BCBS) in three major U.S. cities led to appointments for children just 11% of the time, according to the results of a “secret shopper” survey published in Psychiatric Services.

Phone numbers were frequently wrong, many psychiatrists were no longer accepting new patients, and other calls went unanswered. Moreover, the average wait time for a visit was more than a month, and few of the psychiatrists contacted were willing to accept patients who were covered by Medicaid.

“[O]ur results confirm what many already know: In the midst of a mental health crisis, having insurance is not enough to guarantee access to mental health care when it is needed,” wrote Victoria Chen, B.S., B.A., and Christina Aldrich Barrera, M.D., both of Baylor College of Medicine, and colleagues.

The researchers called 322 psychiatrists listed as in-network by Blue Cross-Blue Shield in Chicago, Houston, and Los Angeles and impersonated the parent of a 10-year-old child who had just visited the emergency department for depression. They asked for an appointment using a standardized script that varied only according to how they intended to pay for the services: BCBS, Medicaid, or self-pay.

Calls were made during normal business hours between July 6 and August 4, 2022, and voicemails were left when the office did not pick up the call. If the researchers did not receive a return call with the requested information, they called the office a second time, approximately one week later, and followed the same protocol.

The callers were scheduled for initial appointments with 34 psychiatrists (11% of the sample). A total of 60 (19%) of the telephone numbers in the database were wrong, and 82 psychiatrists (25%) were not accepting new patients. The average time until the first available in-person appointment was 44 days for all cities, and the average time until the first available virtual appointment was 37 days.

The callers who said they would pay out of pocket (44%) or had BCBS insurance (41%) were more likely to get an appointment with a child psychiatrist than those who said they were covered by Medicaid (15%).

“[O]ur difficulty in obtaining an appointment with Medicaid is particularly concerning,” Chen, Barrera, and colleagues wrote. “This difficulty also highlights the stark reality that those who are poor and hope to use public insurance are frequently denied mental health care. Because COVID-19 has disproportionately harmed racial-ethnic minority groups and impoverished populations, our findings represent a double insult and a deepening inequity in access to care.”

For related information, see the Psychiatric News article “‘Ghost Networks’ Put Patients at Risk of Becoming More Ill” and Updated Milliman Report Finds Worsening Network Adequacy, Psychiatrist Payments.”

(Image: Image: iStock/kali9)


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