Managed Care Plans

There are several factors to consider if you are planning on using your managed care plan for mental health services.

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 everything related to your case to your MCP. The MCP uses this information to determine benefits, which they allocate at their own discretion. This impacts your right of confidentiality and it is possible that your information will be stored in a computer system which could be assessed 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 confidentiality could impact your 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.

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.

MCP's allow a certain number of treatment sessions per year for each plan. This does not mean you can automatically access your benefits. Often you 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. You are often given only one to three sessions to start. You may need to wait for more visits to be authorized, which can take weeks as phone calls and paperwork flow back and forth between your therapist and the MCP. 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. 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.

Misdiagnosing/Over-diagnosing To Get Treatment Authorized

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, or adjustment counseling, unless they are part of the treatment for a serious mental disorder or drug/alcohol problem. This situation puts both the therapist and the client in a negative predicament.

Often the initial assessment period that are authorized are not sufficient to give an accurate diagnosis, but the MCP will not authorize more visits without the initial assessment. This therapist may be inclined to "guess at" a diagnosis, which is not in the best interest of the client. Most importantly, you, as the client, should not be given a mental illness diagnosis that is incorrect, or is more serious than what is true, simply to get treatment paid by the MCP.

The Benefits of Direct Pay

Most clients have found that paying directly for therapy best suits their needs. There are several advantages to paying me directly for psychotherapy. First, your confidentiality is assured. Only you and I will have access to your records, not your insurance company. Confidentiality is the cornerstone of good therapy and professional practice. You need to be able to trust that your personal information is never disclosed without your consent (unless an exception to confidentiality is broken).Your confidentiality can be limited when you elect to use your insurance for payment of services. Second, there are no restrictions on how you find the right psychologist or what services you decide to use. This flexibility is something you will not find if you elect to use your insurance to pay for services. The plan of care and payment of services are discussed and set by mutual agreement between you and I, without third party involvement.

© 2008 Miranda J. Gabriel Psy.D. - Website constructed by Karl Franzen
No photographs of actual clients are represented.