Our current structure of psychiatric payment was partly to blame. Psychiatric care, even through publicly funded programs in medical assistance, is "carved out" to separate psychiatric insurance systems. These insurance programs, often with for-profit status, have already received prospective payments and use separate forms, separate copayments, separate payment regulations, and different criteria for certifying psychiatric clinics before they will release payments for any services. To obtain this payment, then, a medical clinic must establish a separate administrative structure, separate billing processes and collection systems, and separate forms and procedures in the clinic. If a payment is denied, there are separate appeals processes as well.