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Managed Care
and Insurance

 

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Page Contents: Introduction / So what can you do? / HMO Consumer Complaints Hotline / Is there an alternative to Managed Care? / What about Insurance? / Confidentiality

 

 
MANAGED 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.

 


 
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:
 

  

When you sign the papers authorizing third-party payment for your treatment you also sign away your rights to psychotherapist-client confidentiality.

  

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.

 


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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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Raymond Lloyd Richmond, Ph.D.
San Francisco
 
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Psychology is a complex subject, and many issues are interrelated. And so, even though you may find a topic of interest on one particular page, an exploration of the other pages will deepen your understanding of the human mind and heart.

Psychological Practice
To Become a Psychologist
Choosing a Psychologist
Confidentiality
Consumer Rights and Office Policies
Honesty in Psychological Treatment
Legal Issues
The Limits of Psychology
Managed Care and Insurance
Other Applications of Psychology
Psychology: Clinical and Counseling
Psychology and Psychiatry
Questions and Answers about
   Psychotherapy

Termination of Psychotherapy
Types of Psychological Treatment
 
 
Clinical Issues
Becoming a Nonsmoker
Depression and Suicide
Diagnosis in Clinical Psychology
Dream Interpretation
Fear
Fear of Flying: Information
Hypnosis and “Negative” Hypnosis
Medical Factors Affecting Psychology
Medication Issues
Psychological Testing
Questions and Answers about
   Psychotherapy

Reasons to Consult a Psychologist
Repressed Memories
The Psychology of “Stress”
Trauma and PTSD
Types of Psychological Treatment
The Unconscious
 
 
Social Issues
Adolescent Violence
Anger
Family Therapy
Forgiveness
The Psychology of Terrorism
Sexuality and Love
Spirituality and Psychology
Spiritual Healing
 
 
Personality and Identity
Death—and the Seduction of Despair
Identity and Loneliness
Personality
Sexuality and Love
Trauma—and PTSD
 
 
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Autogenics Training
Hypnosis and “Negative” Hypnosis
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The Psychology of “Stress”
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Fear of Flying: Information
Fear of Flying: Treatment
Hypnosis and “Negative” Hypnosis
Systematic Desensitization
 
 
Self-help
Anger
Autogenics Training
Becoming a Nonsmoker
Progressive Muscle Relaxation
Questions and Answers about
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A Guide to Psychology and its Practice

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Copyright © 1997-2017 Raymond Lloyd Richmond, Ph.D. All rights reserved.
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