Tuesday, July 15, 2008

Managed Care: Who Pays?

One of the questions I am most frequently asked in my private practice is whether I accept insurance reimbursement. I have always been happy to provide clients with statements so they may seek reimbursement from their health insurance provider.

However I am part of a rapidly growing cadre of mental health professionals who do not accept health insurance. Following are issues I would urge you to carefully consider prior to seeking managed care coverage for your mental health services.

Is My Personal Information Private? If your managed care provider is paying for your treatment, they will review the details of your therapy sessions. In order for them to authorize a handful of sessions, I must provide them with an extensive list of information. If I don’t have it, I am expected to get it.

The information required is extensive: Has the client ever been in therapy before? If so, what was the precipitating event? Why did they terminate the previous therapy? What is the precipitating event now? Do they use alcohol or drugs, illicit or otherwise? Have they ever been medically treated for their psychological issues? What is their marital status? What is their family dynamic? In short, every conceivable detail of your private life is up for discussion between their case manager and me. This information then becomes part of the documentation which follows you throughout life. Should you apply for health insurance elsewhere, you will have the “mentally ill” stigma following you.

Who’s in Charge? As the old saying goes, “He who pays the piper picks the tune.” If a managed care company is footing the bill for your therapy, neither you nor I are really in control. Rather, a case manager, who is given financial incentive (bonuses, raises, promotions) to deny care, has the power to determine when you are ready to cease therapy. This is, of course, why they call it managed care in the first place.

Their focus is “symptom reduction” and once that has been achieved, there is simply no point from their perspective to continue. This is not to say that “symptom reduction” isn’t a worthwhile goal, but it isn’t the penultimate goal of therapy, either. This leads to the third issue of managed care therapy.

Whatever Happened to Happy? To reduce the power of therapy to “symptom reduction” is to undermine it all together. Psychotherapy in its various forms throughout the ages has been the key to personal liberation and fulfillment. Managed care isn’t particularly concerned with the quality of life or whether you’re happy and peaceful; they just want you to be able to have fewer “symptoms.”

These are three of the serious concerns about allowing managed care to manage your therapy. I urge you to consider them carefully.

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