Linda J. Miller-Dowie, LCSW, CEAP, DAACCS, EMDR Consultant, NLP Master Practitioner
WHY I DO NOT ACCEPT MANAGED CARE REIMBURSEMENT FOR MENTAL HEALTH SERVICES, Ctd.
   
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WHY I DO NOT ACCEPT MANAGED CARE REIMBURSEMENT FOR MENTAL HEALTH SERVICES

 

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You deserve privacy and peace of mind!
REASON #3:  MIS-DIAGNOSING AND/OR OVER-DIAGNOSING IN ORDER TO GET TREATMENT AUTHORIZATION
    Some MCP's will not cover treatment unless it is a "medical necessity."  This may mean the client has to "pretend" they are "sick," or worse off than they are, in order to receive their benefits.
    Most MCP's do not cover marriage counseling, family counseling, sexual counseling, or adjustment counseling, unless they are part of the treatment plan for a serious mental disorder or drug/alcohol problem.
    This situation puts both the therapist and client in a negative situation.  Often the "assessment" sessions that are initially authorized are NOT sufficient to give an accurate diagnosis, yet the MCP will not authorize more visits without one.  The therapist may be forced to select a diagnosis which is not in your best interest in order to get sessions for you.
    Most importantly, you, the client, should not be given a mental illness diagnosis that may not be correct, or is more serious than what is true  simply to get treatment paid by the MCP.

REASON #1:  LACK OF CONFIDENITALITY

    All managed care plans (MCP's) involve direct clincial management by the plan's case manager's.  If you acces therapy through your MCP, it makes it necessary for your therapist to disclose anything and everything related to your case to your MCP.


    This information is used by the MCP for determining benefits, which they allocate at their own discretion.  This impacts your right of confidentiality, and it is possible that your information wil be stored in a computer system which could be accessed by anyone.

    The FBI and law enforcement officials can access your insurance information at any time.  This information could be used to your disadvantage should a legal problem arise.  Furthermore, this lack of confidemntiality could impact your minor children even more negatively.  Should they ever desire to apply for certain jobs or educational programs, such as law enforcement or the military, the information in their insurance files could be used against them. 

REASON #2:  DIFFICULTY GETTING TREATMENT AUTHORIZED

     Due to the direct care management by MCP's and their desire to keep costs to a minimum, getting therapy sessions authorized often becomes a cumbersome and time consuming.  Every plan has diffrerent requirements and standards for authorizations.  Usually they require many hours a week of paperwork and phone calls by the therapist in order to get authorizations.  Some will deny therapy in lieu of taking prescriptions medications or they will require that you take medications for continued therapy.

    MCP's allow a certain number of treatment sessions per year for each plan.  If your MCP allows up to 20 sessions per year of outpatient psychotherapy, this does not mean you can automatically access your benerfits.  Often you first have to be referred by a primary care physician member of the MCP.  Then you may have to go through a phone interview with an MCP case manager.  Then you may have to contact several plan provuiders to find one who is accepting new clients, who has a convenient location, or who has expertise in your issues.  Once you have found a provider, there may be a long wait for an appointment due to the pre-authorization process requirements.  Then you are often given only one to three sessions to start (maximum of 50 minutes per week despite your needs), for an assessment.  Then you may need to wait for more visits to be authorized - often weeks of phone calls and paperwork flowing back and forthe between your provider and the MCP.  Then the MCP may only authorize three sessions at a time, with this continual waiting period in between.  This causes your treatment to be inconsistent, broken up, and can cause you more anxiety not knowing if you will in fact get your benefits authorized at all.  Some people give up on their treatment due to these frustations.

Furthermore, some MCP's want to control the treatment plan.  Some will even dictate the specific treatment plan, which is often very subjective and may and may even be anti-therapeutic.    Some plans will determine when it is time to terminate treatment, even when the client continues to be in distress, or their problem has not been sufficiently solved.