Reason #1 – Conflicts of Interest
As a Licensed Professional Counselor, I am required to avoid potential conflicts of interest. My primary concern is for my client’s well-being. Therapists working under the constraints of managed care companies are sometimes put in the position of having to choose between what is in their own best interest and what is in their client’s best interest. I do not want to be put in that position.
Managed care companies were created to “manage” and contain escalating health care costs. Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for my client. In many cases, therapists who contract with MCC are actually paid to NOT see clients.
Reason #2 – Restricted Choice
Often managed care companies restrict the client’s choice of therapist by offering only short term / brief therapy that I refer to as “drive-by” therapy. Such therapy meets the financial criteria of managed care companies but may fail to afford my client the opportunity to get the information / therapy that s/he wants / needs. It is my belief that this often results in my client’s quality of carebeing compromised. And, this, of course, can result in the possibility of my client’s needs going unmet.
Managed care companies often choose to limit whattherapies are offered, can restrict what is discussed in therapy, and decide which clients can be seen and for how long. Some managed care companies have even included “gag clauses” in their contracts to prevent therapists from suggesting more effective treatments.
Reason #3 – Professional Expertise
I believe that my client should be able to access the full range of mental health professionals according to client needs. Often managed care companies restrict the professionals that clients are allowed to work with – preferring to refer clients to therapists who have a record of providing short term therapy rather than to other therapists who may provide better results or offer a different packaging of services.
Reason #4 – Contractual Limitations
I believe that a client has the right to full disclosure of any arrangements, agreements, contracts, or restrictions between any third party and me that could interfere with or impact your treatment. Managed care companies may label counselors’ choices to advocate for clients in this manner as “Managed Care Unfriendly Behaviors” and take such actions as they deem fit. Typically “violations” such as these result in therapists being removed from provider panels or censured in other ways.
Reason #5 – Privacy / Confidentiality
By contracting with managed care companies, it is likely that I would be required to share my client’s deeply personal information with gatekeepers and utilization review professionals; it would mean potentially allowing literally hundreds of other to have access to my client’s personal information.
Reason #6 – Medication
Research has consistently shown that medication for problems with mood is most effective when combined with psychotherapy. Nevertheless, managed care companies frequently approve medication only for their members rather than permitting them to also work with a mental health counselor. Again, the appearance is that of being more concerned about money rather than my client’s needs.
Reason #7 – Time
Managed care companies usually require therapists to justify and convince Utilization Review professionals before treatment is approved / continued. This is time consuming for the therapist and for the client who is required to continue his / her therapy in “fits and starts.”
Reason #8 – Diagnosis and Stigma
Managed care companies typically cover only those services deemed medically necessary which is defined as being literally about life and death and the treatment of illness. This means that they require a diagnosis of mental illness for my clients.
Info about cost of no insurance vs. using insurance
For many clients, the monetary difference between you filing their insurance claims and they filing their own is nominal. And, for others, paying their deductibles is the equivalent of seeing you 5-10 times. By then, for many clients, their clinical work is over! And, for still others, the services they are seeking to use are not covered by their insurance companies at all – I’m thinking of things like couples counseling.