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.

Tags: Choice, Contract, Courage, Ethics, Packaging