 ANAGED CARE
companies exist primarily to make a profit, and in a capitalistic
society there’s nothing wrong with that. Problems arise when participants
in these organizations need medical care and believe that their medical needs
will be provided for at any cost. This simply will never happen. Remember
what I said: managed care companies exist primarily to make a
profit—they’re not in business to look after your personal
welfare.
Fans of Woody
Allen know the image he has created for himself as the supreme neurotic,
always going to see his
psychoanalyst,
year after year, and yet never getting any better. Well, this approach to
psychotherapy drives managed care companies nuts. “How can we make any
money if treatment never ends!?” they cry. And they’re right. No
one can make a profit at this rate except the analyst.
Unfortunately,
in their drive to cut costs, the companies make other mistakes. Commonly,
they will use solid research to discover what seems
to be a good treatment for many people, but then they will apply this criterion
to everyone. Usually, things more-or-less
work out. Often, however, persons who aren’t like “most people”
need special treatment and tragedy results when they are denied the treatment
they need.
So what can you
do?
You need to recognize
from the beginning what you’re up against. If you belong to a managed
care organization and rely on it for your mental health needs, you and your
psychotherapist will have to fight to get more than the minimum to deal with
your symptoms. It’s quite likely that your assigned psychotherapist
will not even be a psychologist, because psychologists, with all of their
specialized training, cost more money than masters
level practitioners. Your treatment will likely be limited to a few sessions
of
Cognitive-Behavioral
treatment. Someone who doesn’t even know you, and who probably
isn’t even a mental health practitioner, let alone a psychologist, will
be deciding when you should be “cured.” And you should be aware
that many of the uses of psychology that I have outlined in the various pages
of this website will never be approved by a managed care company.
Spiritual healing? Forget it.
But be realistic.
In our society people don’t go to physicians to learn how to stay healthy,
they go to “get rid” of illness. So how can we expect that the
standard approach to mental health care will be any different?
Still, note the
following:
The California
Board of Psychology, in its Board of Psychology Update, Issue No.
4, October 1997, published the following:
HMO Consumer Complaint Hotline:
1-800-400-0815
In the interest of consumer protection, the Board of Psychology
enthusiastically supports the Consumer Complaint Hotline of the Department
of Corporations. The Board encourages all licensees to post the hotline number
in their offices so that HMO patients are aware of the recourse they may
have in dealing with their managed care insurance carrier. A formal complaint
may be filed with the Department of Corporations after a patient has attempted
all available remedies within the HMO grievance system. HMO personnel who
are licensed psychologists must adhere to all ethical principles applicable
to the profession, as well as all laws relating to psychology
licensure. |
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Is there an
alternative to Managed Care?
In the end, remember
the old saying, “If you want to change the world, begin by changing
yourself.” If you want something more than mediocrity, pay for it yourself.
And be selective. Find a psychologist who is willing to work with you to
make treatment effective for you personally and as short as possible to suit
your budget.
Then, I recommend
that you follow a model first suggested by the psychologist Nick Cummings,
Ph.D. many years ago when he foresaw the managed care problem even before
most people knew what managed care was. He suggested the concept of
“interrupted therapy throughout the
life-cycle.” This means that you and your psychologist work
to resolve your problem as effectively as possible, and then you continue
on a less frequent basis (e.g., once a month) or schedule
intermittent visits as you need
them. Physicians work on this model. So do dentists. So do auto mechanics.
Why not psychologists?
What about
Insurance?
Some insurance
companies allow you to see any psychologist of your choice if you are willing
to have a major psychiatric diagnosis be given to you.
Insurance companies are likely to pay only a portion (generally 50% or less) of
the psychologist’s regular fee, however, so you will probably have to make
up the difference out of your own pocket. They also tend to have a yearly deductible;
thus the first one or two sessions will most likely come entirely out of your own
pocket. Finally, insurance companies tend to have a limit to the number of sessions
(often 25 sessions) per year for which they will pay.
Whether you use insurance or a managed care company, remember
one thing:
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When
you sign the papers authorizing third-party payment for your treatment you
also sign away your rights to psychotherapist-client
confidentiality. |
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You lose the
confidentiality
of your treatment because the insurance company can demand any information
about you that it wants and will refuse payment if it doesn’t get the
desired information.
No
advertising—no sponsor—just the simple truth . . .
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Additional
Resources
Related pages within this
website:
Confidentiality
Consumer Rights and Office Policies
Questions and Answers
about Psychotherapy
Reasons to Consult a Psychologist
Types of Psychological Treatment
The Unconscious
CONTACT ME
INDEX of all subjects on this website
SEARCH this website
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