3 Reasons Why I Don't Accept Insurance Co. Managed Care Reimbursement:
1. Protection Of Confidentiality:
All managed care plans involve direct clinical management by the plan's casemanager. If you access therapy through your managed care provider (MCP), it makes it necessary for your therapist to disclose everything and anything related to your case to the insurance company caseworker. This information is used by the MCP for determining benefits, which they allocate rather arbitrarily and at their complete descretion. It is possible that your information will be stored in a computer system which can be accessed very broadly.
2. Difficulty Getting Treatment Authorized:
Due to the direct care management by MCPs and their desire to keep costs to a minimum, getting therapy sessions authorized has become cumbersome and time consuming. Every plan has different requirements and standards for authorization. Usually they require many hours a week of paperwork and phonecalls by the therapist in order to get authorization. Some will deny therapy in lieu of taking prescription medications.
3. Mis-Diagnosing / Over-Diagnosing in Order to Get Treatment Authorized.
Some MCPs will not cover treatment unless it is a "medical necessity." This may mean the client has to "pretend" they are "sick", or worse-off than they are, in order to receive the contracted benefits that their premium payments are intended for.
This situation puts both the therapist and patient in a negative situation. Often the "assessment" sessions that are initally authorized are not sufficient to give an accurate diagnosis, yet the MCP will not authorize more visits without one. The therapist may be inclined to make up or guess at a diagnosis, which is not in the best interest of the patient, nor is it ethical. Most importantly, you, the client, should not be given a mental illness diagnosis that is not correct, or is more serious than what is true, simply to get treatment paid by the MCP.
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
The patient consents in writing
The disclosure is allowed by a specific court order
Suspected child abuse or dependant adult or elder abuse. The therapist is required to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person. The therapist is required to notify the police.
If a client intends to harm himself or herself. The therapist will make every effort to work with the individual to ensure their safety. However, if an individual does not cooperate, additional measures may need to be taken.