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Why I Am Reluctant to Accept Managed Care Reimbursement for Mental Health Services

Dear Clients:

  An important part of your treatment is your "informed consent." In order for you to make an informed choice I have created this "disclosure statement" for your review.

  If you are a member of an HMO, PPO, or other insurance plan that provides reimbursement for mental health counseling, please read the enclosed before making your choice regarding accessing those benefits with me or any therapist.

If you still wish to use your insurance, please contact me as several of our staff are providers with various insurance companies and provider networks.

Thank you,


D. Lee Stoltzfus, M.A., M.S., Ph.D.
Founder and President
L.I.F.E. Management Systems
Licensed Psychologist #8607
Marriage and Family Therapist #6746
Certified Executive Coach

 


Reason #1:

 Lack of confidentiality

All managed care plans (MCP's) involve direct clinical management by the plan's case managers. If you access therapy through your MCP, it makes it necessary for your therapist to disclose anything and sometimes 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, possibly with limited clinical and ethical judgment.  This impacts your right of confidentiality, and it is possible that your information will be stored in a computer system, which could be accessed by many people without your knowledge or permission.

The FBI and law enforcement officials can probably access your insurance information at any time. This information could be used to your disadvantage should a legal problem arise.

Furthermore, this lack of confidentiality 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 cumbersome and time consuming. Every plan has different 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 prescription medications, and some refuse treatment for serious, chronic problems and only cover “short term stabilization.”

MCP's allow a certain number of treatment sessions per year for each plan. Let's assume your MCP allows up to 20 sessions per year of outpatient psychotherapy. This does not mean you can automatically access your benefits. 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 providers 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 pre‑authorization requirements

Then you are often given only one to three sessions to start (50 minutes per week ‑‑ though you may feel you need more), as an assessment. Then you may need to wait for more visits to be authorized ‑ often weeks of phone calls and paperwork flow back and forth 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 clients give up on their treatment due to these frustrations.

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  even be anti‑therapeutic to specific patients. 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. The financial bottom line, many times, is more important to the MCP than treating the patient.  The conclusion of many therapists is that managed care can be dangerous to the mental health of the patient and the therapist.

Reason #3: Mis‑diagnosinq and/or over­ diagnosing in order to get treatment authorized

Most 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 or family counseling, and some don’t cover 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 a diagnosis. The therapist may be inclined to "make up" or "guess at a diagnosis,  which is not in the best interest of the client.

Most importantly, you, the client, should not be given a mental illness diagnosis that is not correct, or is more serious than what is true, simply to get treatment paid by the MCP.

If you have questions about this important but confusing subject, please contact me so we can talk further.

Thank you,


D. Lee Stoltzfus, M.A., M.S., Ph.D.





L.I.F.E. MANAGEMENT SYSTEMS
3429 Ocean View Blvd, Suite K Glendale, California 91208
(818) 248-1140 phone (818) 249-0775 fax
D. Lee Stoltzfus, PhD, CA Psychologist 8607