At Cedarbrook, it is our goal to provide the best services to meet your needs. Quality requires going above and beyond the “usual and customary” services allowed by health insurance contracts. Unfortunately, insurance company payments are inadequate to provide quality services. In addition, many insurers have been involved in price-fixing as evidenced by their settlements with New York State Attorney General in 2009. So the truth is that "usual and customary" payments are not "usual and customary" -- they were set ("fixed") by the health insurance company in order to increase their profits.
Some insurance plans have both in-network coverage and out-of-network coverage. Providers who participate in networks agree to accept reduced fees from members of those networks. "In the old days" network payments were somewhat reasonable so most providers enrolled in the networks. Providers may have believed that getting "referrals" from health insurance companies meant that they would have to do less advertising and balanced out with the reduced fees they would receive. What we didn't realize is that this was the first step in looking at a "volume practice" rather than a "value practice".
For consumers, members generally received quality care from network providers (since "everyone" was in the network). This developed into a mindset that consumers did not seek providers outside of their network because there really wasn't a need to do so.
Two main things have changed.
First, over the years, network payments have not increased enough to allow mental health providers to provide quality services.
Secondly, insurance company out-of-network benefits have been manipulated so that the average consumer can not afford to visit an out-of-network provider. Although 70% of insured working Americans pay higher premiums to have out-of-network benefits -- insurance companies actively discourage or do not allow members to take advantage of those out-of-network benefits.
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