John M. Talmadge, M.D.

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Network Adequacy: Not Adequate

Finding a good psychiatrist is a challenge, but as it turns out it may even be hard to see a mediocre or poor psychiatrist. This is particularly true for individuals who have both psychiatric problems (like depression) along with alcohol, substance abuse, or other addictions.

Deceptive insurance company practices
According to Mark Moran, writing in the April 3, 2015 issue of Psychiatric News, access to psychiatry appears to be an area in which many health plans are offering deceptive products. This problem has been studied for many years in Maryland, near the nation's capital, where access to care has long been a troubled business. Previous studies done over the last 25 years by MHAMD and other organizations found there were long delays for individuals to access psychiatric care. In 1988, MHAMD published, “Study of Mental Health Coverage Provided by Maryland HMOs.”
This study sought to provide a comprehensive picture of the impact of HMOs on access to mental health care. The anecdotes from mental health professionals in 1988 illustrated the long wait times their patients faced when trying to secure an appointment with a psychiatrist. As a follow-up, in 2002, the Mental Health Coalition of Maryland conducted a survey of mental health professionals to ascertain how the managed care system affected an individual’s ability to access mental health care.

Psychiatrists dropping our of private insurance networks
Many respondents reported dropping out of private insurance networks, resulting in more consumers having to pay out of pocket for mental health care. In 2007, the Maryland Psychological Association published a white paper titled, “Access to Care in the State of Maryland.” Their survey found that 44% of mental health professionals listed in the managed care networks were unreachable, and that the average wait time for an appointment with a psychiatrist was 25 days.
In the same April 2015 article, attorney Colleen Coyle, general counsel for the American Psychiatric Association, said that "in many instances health plans advertise provider networks that appear to offer users of behavioral health services a wide range of option for access to care, but in reality those networks may be much "thinner" than consumers are led to believe.

Insurance false advertising is fraud
"In my view, that is fraud," Coyle said. The insurer is promoting a provider list that it knows is not reflective of the access to care that patients will really have. I don't think it's innocent at all."
She goes on to say that insurance plans are constantly looking at their providers and and claims "because that's how they target which providers to audit and whether they are going to challenge the claim."
John McIntyre, M.D., a past president of the American Medical Association, said: "Many insurers, in an attempt to hold down costs, employ very narrow or shallow networks that are inadequate to provide necessary medical care. But patients don't know that when they sign up."

The detailed report from The Maryland Mental Health Association is available online here.