I have made the choice not to contract
with managed care companies
for my professional services.
Here’s the 8 reasons why . . . .
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.
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 care being compromised. And, this, of course, can result in the possibility of my client’s needs going unmet.
Managed care companies often choose to limit what therapies 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.
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.
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.
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.
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.
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.”
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.
My practice is solution- focused on quality of life and personal goals. My work with clients focuses on prevention, exploration, and personal growth rather than simply survival. We typically talk in terms of possibility and resourcefulness, gratitude and integrity, commitment and personal responsibility. Working with managed care companies is not a choice that I can ethically make.
I Know Better
I have mental health professionals declare on a regular basis that you “can’t survive in private practice without participating in managed care.” But, I know better. What I know is that you can’t thrive – both personally and professionally – while participating in managed care.
Once I realized the ethical implications of working with managed care companies, I terminated all of my contracts with managed care. It’s not a decision that is right or necessary for all therapists but it was the best decision that I’ve made to date.
I am now celebrating 10 years of being an insurance-and- managed-care-free private practice. I’m thriving and you can, too! All it requires is courage.
If you, too, run a practice without managed-care, I hope you’ll drop in here to chat about your experiences. And, if you have yet to make the choice to opt out of managed care, I would be happy to help you find your courage and to help you create a path to a fee-for-service only practice.
Great info, thanks! There is a piece of me that feels very conflicted about not working with low income individuals- do you alleviate this concern by offering any sliding scale spots?
Robyn, I have several thoughts about this. The short answer is that I do set aside some “slots” for reduced fees. I’m going to write a post on this shortly to give you some ideas about how to handle these choice points. Stay tuned!
Well said about managed care. However, I am curious about how to offer services to low income.
Doesn’t the mental health parity act do something to address this issue?
Hi, Travis! That’s a good question but, no, it really doesn’t. At least, not in the grand scheme of things.
“The Mental Health Parity and Addiction Equity Act of 2008 requires group health plans and health insurance issuers to ensure that financial requirements (such as co-pays, deductibles) and treatment limitations (such as visit limits) applicable to mental health or substance use disorder (MH/SUD) benefits are no more restrictive than the predominant requirements or limitations applied to substantially all medical/surgical benefits.” Here’s are links to a Fact Sheet and a FAQ Sheet on MHPAEA of 2008.
The truth is that the restrictions and limitations of working with managed care are equally applicable to dentists, physicians, and mental health professionals.
I am beginning a new practice and do not want to contract with managed care for the above reasons, in particular the loss of privacy. I would, however, like to provide a bill that could be turned in to insurance should the client so desire. Would this place me in a position of being required to provide data to the insurance company?
Hi, Verline! I think you are on the right track. I do provide a bill to my clients that they, in turn, may choose to submit to their insurance companies for reimbursement. This does NOT require me (or you) to provide any data to the insurance company.
In the event that insurance companies need additional information i.e. clarification about dates of service, diagnosis, or supplemental information, I provide such information only to the client for him / her to submit to the insurance company if s/he chooses to do so.
I have had an insurance company attempt to communicate directly with me about a client by telephone. I simply explain that I have no authorization to confirm / deny that I have a client by the name of ____________ and then I refer them back to their own client for additional information.
Like Verline, I will be starting in private practice with psychologist who has 20+ years of experience, but does deal with managed care. I have worked as a licensed counselor for 6 years now (in state-funded agencies) and ready to make the leap into private practice. Excited but also a little nervous because so many clinicians assume and tell me that I must get on panels to see patients, otherwise, they will not be interested or able to see me. I do not agree, but I want to to know how can I make this work from the “get-go” for someone like me with 5+ years of experience in the field, but new to PP? Thanks!
Hi, Cynthia! Thanks for dropping in! You absolutely DO NOT have to work directly with managed care to build your private practice! In fact, my experience has been that because my hands have not been tied by managed care – dictating who can see me and for how long – I have a full and busy practice. And, I am not alone. (Perhaps others reading this can speak to their own success in building independent practices?)
The key is in helping potential clients understand the full implications of you working without the constraints of insurance companies and also understanding the financial differences up front. 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.
Just take the time, Cynthia, to get really clear in your head about the benefits and costs to your client when they work with insurance. Then, you’ll have a truly informed discussion with they about why you choose not to work with managed care. It won’t be a sales push or a snow job. It will be you informing your client of ALL the implications rather than the ASSUMED implications of working with managed care.
Robyn, I love the idea of not working with managed care, for many of the same reasons you stated, but I am concerned about generating enough business…so many of my clients either have the financial need or a desire to “use” their insurance benefits that they are paying for. How do you find enough clients that are willing/able to pay directly for services?
Jennifer, in my experience, it’s FEAR rather than not enough clients that keeps a therapist’s calendar less-than-full. Think about it . . . between my family members and neighbors, friends, and colleagues, there’s PLENTY of folks needing our services. The “trick” for me has been to differentiate myself from the other therapists up and down the street i.e. niche, niche, niche and to be bold enough to ask for what I truly want.
In the last 12 months, I’ve had 1 client choose not to work with me because I did not work directly with insurance companies. Once they understand why I choose NOT to work with managed care and how that choice benefits them, they are typically grateful that a professional counselor took the time to fully explain the implications of the choice.
Tamara,
Hopefully, your page is a God send. Today after practicing for over 15 years in a rural part of West Texas, I was at my wit’s end and nearly in tears. Another night spent until midnight reviewing authorizations and new forms and overwhelmed with 4 companies wanting to use their own credentialing classes for trauma training that are “required” to be on their panel. It is crazy! I have specialized in trauma work with some of the best training available already. It is really overwhelming to think of all of the hours of paperwork and now more training. I hope that finding your site is a beginning of a new path for me.
Mary
Hi, Mary! It’s so nice to meet you and thanks so much for dropping in here to check out Private Practice from the Inside Out! I can so relate to where you are! I was chained to managed care for the first 7 years I was in private practice. I thought that’s what we had to do to survive. But, what I learned was true for me is that it was killing me! I was jumping through so many hoops so fast and I believe it was unknowingly at my clients’ expense. I realized along the way that I was continuing to play with them out of fear and nothing else. Now, that may not be true for you or a lot of other people but I can see that it was true for me.
I count one of the best days of my entire life being the one on which I resigned from the last managed care company. It was scary at the time but I promise you, it was much more freeing than anything else I’ve done! I don’t know exactly what you are looking at changing for your practice but if there’s questions you have or anything I can do to support you in re-shaping your private practice into the practice that you love, please don’t hesitate to speak up!
If you sign up for my email updates, you’ll receive emails usually twice a week letting you know I have posted new information. The online community here is supportive of each other and it is growing. I hope you’ll add your voice often – letting me know what you like and what you need and letting your peers here know that you are supporting them, too!
Again, Mary, I’m so glad you dropped in and took time to introduce yourself. I look forward to chatting with you!
I have been in private practice for three years and have never accepted insurance because of the same reasons and more as stated above. I have always had a full practice. The most important thing is that you need to be good at what you do, believe in yourself and in your clients’ abilities to heal. Then your schedule will be as full as you want it to be. We all belong to communities who need good therapists, and they will gladly pass on your name as a referral to the people they know who need help as long as you have been effective with someone they know. It’s a season for our profession. People are hurting; the sandbags placed downstream from the past 25 years are being overrun by the flood of hurt as the family disintegrates. It is not by coincidence that we are in place to do this work at this time in the history of our world. There is a need, and if we do it well, insurance or no insurance, we will fulfill our mission to bring healing in the emotional realm to so many in need.
Kathie! Welcome to Private Practice from the Inside Out! And, thank you for such a thoughtful comment! I completely agree and couldn’t have said it any better!
I hope you’ll drop back in and introduce us to you and your practice!