It is currently Wed Aug 23, 2017 11:11 pm



All times are UTC - 5 hours [ DST ]


Our Sponsors





Post new topic Reply to topic  [ 5 posts ] 
Author Message
 Post subject: Doctors / insurances
PostPosted: Fri Jan 15, 2016 2:14 pm 
Offline
Average Poster
Average Poster

Joined: Thu Oct 15, 2015 10:27 pm
Posts: 4
None of the Doctors in my state that prescribe suboxone are associated with any insurances.
I mean none. In other words there is no way to get financial help with these monthly visits. I'm frustrated and I would love to hear anything that may help. I would love to hear feed back.
Are these 200 dollar monthly visits tax deductible?


Top
 Profile  
 
 Post subject: Re: Doctors / insurances
PostPosted: Fri Jan 15, 2016 9:25 pm 
Offline
Site Admin
Site Admin
User avatar

Joined: Sun Feb 24, 2008 11:03 pm
Posts: 1545
The costs are tax deductible if you itemize, and if the costs exceed a certain percentage of your income. I think that amount is 7.5%, but I could be wrong. If you have a business, then you can deduct the expenses through an employee plan (as long as all employees are included). Your employer may also have an option to enroll in an HSA-- Health Savings Account-- where pretax dollars can be used for health expenses.

I don't expect people to appreciate my point of view, but I'll share it just so you see where many docs are coming from. I realize that most people have no sympathy for the financial situation of doctors. But in all honesty, I know a number of docs who are in deep financial holes, who will never climb out. The docs who go into cardiac, ortho, or plastics will end up making high-six-figures and eventually own big houses. But the risks of a medical career are high, for the reasons I'll explain.

One of my kids is looking at career options, and one option would be med school. She has worked very hard in HS and college, and she could probably get accepted. But the cost, for in-state tuition, is $50,000 per year for 4 years. That cost doesn't include anything other than school-- i.e. it does not cover rent, food, insurance, automobile, or any of the other costs of life. All med schools are in cities, so the cost of living tends to be higher than in rural areas. There is no way to go to med school without borrowing at least $200,000-- and that is for one of the cheaper schools. There are certainly no cheaper options in Wisconsin. Understand that the cost of med school is AFTER the cost of 4 years of college-- which is another $100,000-$200,000, at least for people who don't qualify as 'desirable' by college admissions programs.

I see 2 people per hour in my practice-- 30 minutes per person. I charge $200 per visit. I use that money to pay for office staff and expenses, rent, malpractice, licensing and mandatory continuing education, utilities, and my own salary. If you multiply it out, it looks like a lot of money-- but understand that many patients miss appointments, leaving gaps in the schedule-- especially in addiction work. Every day includes an hour or two for work that cannot be billed-- such as doing the business work, making phone calls, answering emails, speaking with family or social workers, testifying in court, filling out FMLA or disability paperwork, etc. I spend at least an hour each day just documenting visits-- which is a colossal waste of time, but can't be avoided when working in this field.

If I join an insurance panel, they will pay me $60 to see a patient in their network. When I complain that I can't keep the lights on for $120 per hour gross revenue, they tell me to see 6 people per hour. But at the age of 56, I can't keep up that pace. More importantly, psychiatrists who see 6 patients per hour provide very shitty care. When you consider the time of shaking hands and walking in and out of the office, that provides about 5 minutes for each appointment.... assuming that patients are always on time, and the office is very efficient. Of course that leaves no time for the phone calls, documentation, and FMLA paperwork.

Many people will disagree... but I think that any person who works hard enough to graduate from a good college with better than a 3.8 GPA, who then spends 4 years in med school, and then spends 4 years in residency (where 80-hour work weeks are the norm), borrowing $200K-$400K during that time--- should deserve to make $200K per year. The progressive tax system means that a person making that much will pay about 50% income tax marginal interest (i.e. not on the whole amount, but certainly on any amount above about $130K). Student loans continue to charge 8% interest even when mortgage rates are less than 4%... so those $300 K loans continue to grow by over $20 K each year from interest alone. So by graduation, $300 K has become $500 K. Loans and interest for college and med school are NOT tax deductible. They also cannot be discharged by bankruptcy.

When patients look at their in-network choices, they should realize that some people pay $6,000 for insurance, and some people pay $30,000 for insurance. Actually, some people pay almost nothing for insurance and have medicaid-- which will pay me $36 for an office visit. I find it bizarre that some patients pay nothing for my time-- for the education and license that cost me hundreds of thousands of dollars and countless hours of work-- and other patients pay a reasonable charge. So I've chosen, for the last 15 years of my career, to opt out of insurance networks. This way I get to see patients for 30 full minutes (or 60 minutes if they feel that the time is worth paying for). Every patient pays the same cost-- just as they do at restaurants, grocery stores, attorneys, and clothing stores. I realize that some people see healthcare as a 'right' that shouldn't cost anything.... but I had no 'right' to get free training as a doctor. I borrowed a LOT of money, just like most doctors do.

I don't know who would even go to med school these days--- which is a frightening concept for those of use who know how difficult medicine can be these days. I love my job, but I cannot promise prospective students that they will love medicine 20 years from now.

I am also a healthcare consumer who buys my own insurance, so I understand that side of things. In my town, there used to be 5 in-network psychiatrists. Now, there are zero. The in-network docs either retired or relocated to areas where insurers pay more-reasonable rates. I'm still here, charging the same fees I charged in 2010. People often call, hear that I'm not in-network, and drive an hour to see someone else. But I see many patients who have medicaid, who are willing to pay the cost in order to have a full 30 minutes, always starting on-time. I know this sounds like a sales pitch--- but I'm not taking new patients. This is just the reality of psychiatry, at least for now.


Top
 Profile  
 
 Post subject: Re: Doctors / insurances
PostPosted: Sat Jan 16, 2016 3:09 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4141
It is always to our advantage to look at things from a new/different perspective, so thank you, Dr. Junig, for explaining that (and not for the first time).

I am grateful to have a provider who takes my insurance, but he is a general practice doctor, not a psychiatrist. You are obviously not taking advantage of your ability to prescribe the drugs that we need. There are practices where the doctors charge much more for a 10 minute visit in cash. There is a big difference in the doctors/clinics taking advantage and the ones who are just trying to make a decent living.

I myself will probably have a debt of $40,000 by the time I earn my masters degree and I don't think that addiction counseling is a particularly lucrative field. However, my husband, who is 61, has already earned a pension that will pay most of our bills when he retires. I'm hoping that my salary covers my son's college tuition which starts in a year and a half. It seems more and more difficult, however, to maintain a middle class lifestyle. We've compromised by only having one child and not upgrading from the townhome that my husband bought in the mid 1980s.

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
Our Sponsors
 Post subject: Re: Doctors / insurances
PostPosted: Thu Jan 21, 2016 1:05 pm 
Offline
Average Poster
Average Poster

Joined: Thu Oct 15, 2015 10:27 pm
Posts: 4
Thank you both for your responses. I appreciate them very much. That was definitely a new prospective. I will obviously continue to see my doctor at the clinic. He is wonderful and I am grateful to them for all that they do. I do not believe that I will be able to deduct these expenses on my taxes this year but next is a different story. I just did the math (thank you Dr. Junig).
So again, thank you both... and done is much better than perfect :)
BTW
I need some recommendations on literature that will help me through this. I am currently feeling like I lac the skills to process certain situations. Dealing with stress-hell real life - is new to me and I find that I'm quick to get angry or overwhelmed. I know that I need to retrain my brain on how to deal with these things but where do I start?
Any suggestions???


Top
 Profile  
 
 Post subject: Re: Doctors / insurances
PostPosted: Sat Jan 23, 2016 11:00 pm 
Offline
Moderator
Moderator
User avatar

Joined: Thu Feb 23, 2012 4:42 am
Posts: 4141
I don't know any helpful books myself as most of the books I've been reading are academic in nature, but maybe some others will come along with good suggestions.

I think that this would be an excellent time to look for an addiction therapist. I have one I can still call if I need an appointment. With my insurance I paid $60 for an hour with her. Many therapists have a sliding scale depending upon income. An addiction counselor will be trained in several modalities that can be very helpful to an addict. Learning to live life on life's terms is difficult when you've been numbing yourself for years. One other thing that might help is journaling. Keeping a journal could help you notice patterns of thinking and possible triggers. It can help you work through some family issues too. You can always ask specific questions here too. We're all broken people trying to put ourselves back together again. There's probably not much you could bring up that someone here hasn't experienced. Try us!

Amy

_________________
Done is better than perfect!


Top
 Profile  
 
Display posts from previous:  Sort by  
Post new topic Reply to topic  [ 5 posts ] 

All times are UTC - 5 hours [ DST ]


Who is online

Users browsing this forum: No registered users and 0 guests


You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Our Sponsors
Suboxone Forum latest topics RSS feed Subscribe to the entire forum
 

 

 
Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

Powered by phpBB® Forum Software © phpBB Group