Shopping for Healthcare

Some thoughts about shopping for healthcare in the US now…

Generally speaking, we in the US have more availability and better healthcare than most of our fellow now 8 billion people on the planet – and also, we have tremendous difficulties here, with some countries generally better in this regard (usually countries with smaller and more ethnically homogeneous populations). Our overall US way forward will be with best social systems for human and environmental well-being (public health and clean environment are bigger determinants of overall health than individual medical care). *Please consider putting energy into helping build that future in whatever way you can, including voting however you think would be most helpful.*
Here and now, finding support (access) can be difficult. *Don’t be too discouraged if it takes some time to find providers. Stay with the process.*
If you’re not finding exactly what you want, consider starting with whatever you can arrange, then making changes. This can mean starting meds via a PCP; talking with whatever counselor (professional, friends, religious, phone and internet support lines, computerized, apps etc), then possibly switching to a specialty mental health prescriber, combo talk and prescribing with one provider (this is less and less available), a different talk counseling approach, etc. All this while optimizing your social relations, exercise, diet, general health and such, as best as circumstance allow.

Here are some aspects which might be good to consider:
Combo prescribing plus talk therapy, or separate: Both have arguments for and against. I usually feel combining these might be best, to allow easier holistic discussion. But depending on the situation, I sometimes prescribe for some folks who have other talk therapists (or aren’t currently in talk therapy), or do the talk therapy part with folks who have someone else prescribing (or aren’t currently taking mental health meds.
“Hmm…maybe I shouldn’t use insurance to meet, and just pay directly myself…”: *Do* use your health insurance if at all possible. Certainly, it’s true that using insurance brings hassles regarding billing and payment, confidentiality concerns, etc. But in my experience, confidentiality laws are almost always well-followed currently in the US, and billing generally goes through okay, with problems (almost) always resolvable, albeit sometimes with time needed for that. Some folks intend to pay for meetings (sliding scale) on their own, but over time most gradually feel burdened from paying themselves like that, and decrease services below what they intended and may best benefit from. That being said, I do work with some folks who pay directly, for this or that reason, if they strongly desire that.

How do I find counselors and mental heath medication prescribers?

Primary Care Physicians/PCP’s: Most mental health medications in the US are prescribed by primary care physicians/PCP’s, and that often goes well. PCP’s are among my heroes in health/human services, with broad scopes of knowledge and responsibility; each one is of course different. Each may have particular approaches to psychiatric medications because of the system they’re in, or their own personal stance or level of experience, etc. Feel free to ask them.

  • Often PCP’s may “bridge” prescribing meds for a month or two, while someone is looking for an ongoing psych prescriber. This is one argument for making having a PCP a high priority, when moving to a new area, when changing insurance necessitates provider changes etc.

    Consider asking the PCP office about possible mental health providers. PCP’s increasingly have mental health counseling and prescribing supports within their organization. This can include coaching for the PCP prescribing mental health meds, separate mental health providers at the PCP clinic or another office, etc. Often, PCP offices have lists of providers in the community, outside of their system.

  • The more complex the medication situation is, the more likely it is that a PCP will ask a person to see a psychiatric prescriber (M.D., D.O., prescribing nurse, etc). This may include controlled substance prescribing; meds needing blood monitoring; people who’ve had challenges with meds, who might benefit from more in-depth specialty assessment, etc.

Insurance: If you’re close to changing insurances and trying to secure a new provider, clarify whether possible new providers will take your new insurance – or perhaps wait until you have the new insurance in hand. It can take time to set care arrangements initially, frustrating to have to change providers soon after starting.

  • Consider asking your insurance company for help finding health providers. Sometimes I get calls from insurance company workers who say that a person with their insurance hasn’t had success on their own finding a provider, so the insurance company is taking on some of that search. At least some insurances do this.
  • If you have problems with insurances (not uncommon, given complexities and frequent changes in companies, plans etc.; inadvertently, different understandings from different contacts, etc), log your experience (who you talk with at what phone number when, and what they specifically say), ask for supervisors, ask my billing company for help if we’re working together, and go to your state insurance commissioner if need be.
  • Insurances do business in a state with permission of the state government; sometimes insurances are most helpful when responding to state regulator intervention. That being said, sometimes state insurance oversight offices can themselves be challenging to interact with, with burdensome processes to get help. But it can be worth the hassle.

Other settings, for possible off-hours supports:

I simply work alone, can’t respond “24/7/365”, and thus need to rely on public emergency services if need be and I’m not immediately responsive. Some people benefit from meeting with mental health providers in settings where “off-hours” coverage is available in emergencies. For example, sometimes a hospital episode can be appropriately avoided by talking during a weekend with a worker on duty who is at least somewhat organizationally connected to one’s own ongoing provider, to perhaps set a next day appointment, or other crisis support.

Provider search detail logging:

It can help to keep a clear record of what providers are recommended to you, calls to potential providers and insurance you make, etc. Record phone number, date, what happens – left a message, who you talk with, etc, and next steps (await call back, other number to call, etc). Besides keeping organized, this can show your diligence to an insurance company, state regulator, etc.

Specialty treatment areas:

Do consider whether you want to look for a provider with any specialty niche interests, experience, training, etc. I put some examples of some specialty community provider-search websites on the “Resource Links” page. Consider the background of folks listed on provider-search websites. For example, many providers have some schooling in yoga-mediation etc range of practices which have flooded into Western/Global North healthcare in recent decades. There are a few practitioners who have perhaps highest level training (a doctor-level degree or similar), and folks who’ve had a short seminar instead.

My own schooling is Master’s (not PhD) level in Buddhist psychology; “mid-level” regarding Jungian analytic training, and current cognitive, dialectical, psychodynamic etc approaches; “experienced, with some specific training” working with Muslim (not Muslim myself), and poly/open/consensual non-monogamy folks.

Specialty assessments:

Some specialty mental health assessments (family or other legal, disability, insurance, substance use and other addiction, etc) must be, or may best be, done by practitioners who specialize and/or have particular training, etc in that field. Many times, PCP’s play this role (with short-term disability notes, for example.)

A note on substance use concerns/assessment/treatment:

Including some group treatment is an important part of substance abuse recovery. One-on-one counseling is generally not as robustly helpful on its own. I have years of experience in substance use treatment provision and certainly work with folks with such challenges in my current work setting. And also, if a person has substance use as a prominent part of their current concerns (if they know that, and/or this is a perspective I come to as we meet), I will likely continue work with them only if they have a focused and thorough assessment by another qualified practitioner who is in a setting where substance concerns are the primary treatment focus.

Ketamine, marijuanas, psychedelics, electroconvulsive therapies:

I am not qualified to assess for, prescribe or administer any of these – and also, I support people exploring their use (in qualified study or other appropriate, legal treatment settings). I may well continue talk and/or medication prescribing roles with people are also undergoing such specialty treatments with other providers, if desired.