Impacts of Managed Care on Therapy

Even though health care is a hot topic, people often lack awareness of how policies directly affect them. “Behavioral health” (a.k.a. mental health insurance) is no exception. Rather than being put off guard by unexpected impacts, the following is an overview of some main issues that surface when an insurance company becomes part of your therapy. Armed with information, you can then make an educated decision about utilizing insurance benefits or paying out of pocket.
Impacts

1. Confidentiality
Insurance companies require a therapist to provide personal information for reimbursement. This includes a diagnosis, services rendered, and the duration of treatment. Because they also have case management to determine medical necessity, they may also request access to case files for specifics about the treatment plan and other sensitive information. The concerns include:
a. Providers are unable to control how the private information is handled once it is in the hands of the insurance company.
b. It is common for managed care entities to allow outside parties access to information, such as the client’s employer, government entities, other insurance providers.

2. Utilization of therapy
Managed care requires there to be something wrong (pathology model) to justify the expenditure. Many people have come to believe that the need for counseling suggests they must be mentally unstable or weak to need help.

3. Stigma that may have long term impacts.
Our society continues to have detrimental assumptions about mental health. There are documented cases of individuals being denied insurance (home owner’s, life/term) due to participation in counseling. There is also the problem of pre-existing conditions which impacts the accessibility of not only services but also mediations. The new health care law will hopefully address this last point.

4. Limiting Access to Providers
Part of the cost-containment strategy is to contract with individuals willing to take a reduction in their fees and comply with the insurance companies policies. There is no guarantee, however, that they will have someone on the panel that has the necessary expertise to address a client’s needs. A colleague of mine highlighted that you may by a pair of shoes on sale but they are little good to you if they leave you with blisters.

5. Determination of treatment
For those who are in-network, they may not always be able to practice in the way they feel best suits the client. Dr. Miller (1998) expresses concern that utilization reviewers often lack the expertise to challenge a course of treatment. He writes, they “often have merely a bachelor's degree or a master's degree with limited experience. These reviewers routinely overrule and change the treatment decisions of greatly experienced specialists with a master's or doctorate degree.” In addition, without any knowledge of the client’s context or the dynamics that surface in therapy, they are lacking vital information that significantly impacts treatment decisions.

6. Fewer benefits than regular health insurance
Some insurers do not offer any mental health coverage; others have high deductibles that must be met before the benefits take effect or have co-pays that are little reduction in the cost. There is also a common practice of limiting the number of allotted session, regardless of need. This means that services are based on fiscal impact rather than what is best for the client.

Utilizing insurance is a highly-individualized decision. Be an informed consumer! Know your rights, determine the cost-benefit ratio, and ask questions. That way, you can make a choice that right for you. Once determined, you can then focus on your needs rather than on whether to use your insurance plan.