I spent 23 years in private practice as a psychiatrist. I took all insurance including medicare and medicaid. I worked very hard, was available by beeper 7 days a week and made very little money. I needed to use my wife's health insurance (a nurse). This is why half of psychiatrists and many therapists do not accept insurance. It makes their lives impossible and there is no money built in for staff to take care of the administrative work. Medicare and other payors must rebuild the fee structure and expectations of practicioners who accept these fees.