Insurance/Managed Care

If you are covered for mental health treatment by an insurance company — either via a preferred provider policy (PPO) or managed care plan (MCP) — and want to use your benefits to pay for therapy, it is important that you know the following:

• I choose not to be on a panel of providers for any insurance company or managed care firm.
• While most of the major PPOs still will pay a significant portion of my fee (depending on your plan), they will not pay for all of it.
• Some MCP firms will reimburse part of my work with you, though most will not.
• I will provide a monthly statement for you listing the sessions held and the fees paid, and complete a basic insurance reimbursement request, but I ask that you file for any benefits that you are due.

Why have I steered clear of being on insurance panels, especially managed care?

Mainly because of the loss of confidentiality, which I believe then impacts negatively on the environment of trust and safety that you can have with me. For therapy to work, you must feel free to disclose some difficult and often painful information, and patients are naturally less likely to do that if they aren’t sure who else is going to have access to that information.

All managed care plans (MCPs) involve direct clinical management by the plan’s case managers. If you access therapy through your MCP, it makes it necessary for your therapist to disclose anything and everything related to your case to your MCP.

This information is used by the MCP for determining benefits, which they allocate at their own discretion. This impacts your right of confidentiality, and it is possible that your information will be stored in a computer system, which could be accessed by anyone.

The FBI and law enforcement officials can access your insurance information at any time. This information could be used to your disadvantage should a legal problem arise.

Furthermore, this lack of confidentiality could impact minor children even more negatively. Should they ever desire to apply for certain jobs or educational programs, such as law enforcement or the military, the information in their insurance files could be used against them.

In addition, there is a mountain of paperwork and phone calls that these organizations require to get treatment authorizations, which take a significant amount of time. They also often limit the number of sessions needed to a preset limit, rather than basing that decision on what the client needs.

Furthermore, some MCPs want to control the treatment plan. Some will even dictate the specific treatment plan, which is often very subjective and may even be anti-therapeutic. Some plans will determine when it is time to terminate treatment, even when the client continues to be in distress.

I believe that treatment should be at your discretion, with input from me, your professional mental health provider. Thus, I prefer to operate on a fee-for-service basis — knowing that you are best protected in this manner, and that I can offer you the best treatment possible.

If you have any questions about this policy, please ask me.