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  • Lisa E Goldman, MD, MSW

Dear Doctor Goldman, do you take my XYZ insurance?

Updated: Feb 13, 2021

Dear Inquiring Patient, Thank you for asking this important and highly relevant question. The short answer is NO, I don’t “take” insurance but YES I will help you bill your own insurance as my services are billable to many insurance plans as an out of network provider. The bottom line is that you pay me when you come in to see me and I take care of you and provide you with a one page billing form so that you can BILL YOUR OWN INSURANCE and then they may or may not reimburse you- ie- pay you back for part (usually not all) of your services with me by SENDING A CHECK TO YOU, not to me! If you want to know why I decided to practice psychiatry this way, please read on. I love taking care of patients and they appreciate the unhurried and highly personalized attention I give them. I left “employed physician” jobs (working for big clinics and hospitals) because I did not like the way I felt pressured to shove patients through the exam room like tacos at a fast food restaurant. I followed the lead of other Escaped Doctors like Pamela Wible MD who were leaving what she calls “big box medicine” in order to start my own low overhead, low pressure, small volume, patient centered psychiatry practice. My patients love the full session with me that lets us take the time we both need in order to get to the root causes of their discomfort. This extra time and uninterrupted attention permits direct eye contact between the doctor and the patient, not the doctor and the computer screen. It lets me take care of my patient and not just focus on clicking boxes on a screen to make sure I get paid. This way of practicing patient centered psychiatry lets me take care of each patient as a unique and highly complex whole living person, not just a collection of disease symptoms that I can bill for as if each symptom were it’s own separate entity with the patient just bringing in their symptoms but never showing me their whole true self. I am here to take care of whole human patients, not to simply manage disease symptoms. My relationship is with my human patient. Not with their medical record, not with the symptoms and diseases I can bill for, not with the pharmaceutical companies who want me to push their newest drugs, and certainly not with their insurance companies who have never met the patient and don’t want me spending any extra time with them. Because I decided to focus all my mental, physical, and emotional energy on my patients, I am very good at what I do. I enjoy connecting with and helping people, and I look upon psychiatry as the format or skill set or discipline I use in order to fulfill what I believe in my heart I was called upon to do as my life’s work. Because I have spent nearly 20 years of my life in training to be not just a psychiatrist (a medical doctor who prescribes pills to treat patients who suffer from conditions or experiences we as a society have agreed to call “mental illness”) but also a psychotherapist (a person who listens deeply to the messages of the mind, heart, body and spirit of their “patient” or individual in care) I offer a service to my patients that is very tough to find elsewhere. By committing my life to practicing the kind of old fashioned psychiatry in which I slow down, listen, and pay attention to the whole human being, I have been told over and over again by other people that I am very good at what I do. By not “taking” insurance I am afforded the ease and unhurried quality time to spend with each individual patient. If I were to compromise, and “take insurance” I would have to see a larger number of patients for shorter periods of time, do a less personalized and less thorough quality of work with them. This is production driven medicine. If your doctor is grumpy, irritated and in a hurry and doesn’t appear to be listening to you, it is because they are miserable and unhappy working in this production-driven medical setting. In this model, the doctor has to rush through each patient visit as quickly as possible, in order to be able to afford to make up the revenue lost by needing to hire office staff to bill the insurance companies. This amounts to taking care of insurance companies and putting patients needs behind the needs for pursuit of financial profit. In my experience, this form of high pressure, hurried, superficial production driven medical care (rushing through 20 or 30 folks a day so doctor can chase the insurance dollar) doesn’t serve the needs of the patients. The doctors aren’t happy being forced to rush through each visit and that’s why they seem irritable and like they are not listening. I worked in a fast food restaurant during high school and college and the similarities between working in fast food and working in a production driven clinic or hospital are striking. If you want fast-food drive by medical care, stick with your insurance company. The insurance companies make their money by giving you less care. In order to make a profit, the insurance companies have an incentive to ensure that they collect more money from you on average, in the form of insurance premiums (what you pay them) than what they have to shell out, on average, to cover the costs of your medical care. The more claims they deny, the more medical service they refuse to pay for, the more money they get to keep. This rips off patients and doctors alike. Instead of calling this system “managed care”, it would be more accurate to call this “managed DON’T CARE”. Under the “managed care system” (or managed DON’T CARE system) you can count on getting lousy medical care from unhappy doctors who don’t have time to give a crap about you. If they stopped and listened to you, they would be late for the next patient and then they will be punished for “falling behind” and “not getting the job done fast enough”. No fun for doctors and terrible for patients.

What I offer is something different. I offer patient centered psychiatry. I won’t see more than 5 to 8 patients in a single day, because I want to give each person my full undivided unhurried attention. The deep listening I offer my patients is unlike anything available in a big box clinic. I won’t push people through my office in an effort to collect their fees. I make myself available to people in need through giving them the actual psychiatry attention that will be helpful to them because that is my true purpose in life.

I love what I do and I love seeing my patients bloom. To help this happen, I give them my full attention and enough time to listen deeply and really hear them. The doctor patient relationship itself has been shown by multiple studies to be a key factor in improved patient wellness and patient satisfaction.

So no, unfortunately, I will not take care of your insurance company or their needs. But I will take care of you. I hope you will schedule with me IF you feel I am the right fit for you.

Warmly, Dr Goldman

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