(The Trouble With) Insurance and Mental Health

I have made the conscious choice not to work with the managed care (ie. insurance) industry in my practice.  While sometimes frustrating to new clients, this was not a poorly conceived choice but, rather, a decision made after long and careful deliberation on my part.  As we shift into 2014 and the true emergence of the Affordable Care Act, I wanted to take a moment to offer some clarification as to why I have decided not to accept insurance from my clients in favor of a fee-for-service model. 

My goal is to assist others in empowering themselves and coming into greater contact with the world around them.  I have invested significant time and energy in my training and personal development in order to be the very best I can be at offering my services.  Yet, far too often,  clinicians working in the managed care system are expected to provide only the minimum of care to clients and to complete treatment in ridiculously short periods of time (at times only being authorizing to conduct six to eight treatment sessions). 

In addition, managed care staff often seek extremely detailed and intimate information about clients and the content of psychotherapy sessions in order to approve (or deny) treatment.  This information is entered into a computer database, the security of which is beyond my (or my client’s) control.  I have deep concerns that this deeply personal and confidential information can easily be available to others within and beyond the managed care organization, shared with other insurance companies, or even sold to (or hacked by) unrelated parties.

Case in point, the federal government and insurance industry has developed a national database of medical and mental health records, in which your managed care records are stored.  Regardless of intention or regulation, there is no way to tell how the information from the national data bank will be utilized.  I habor concerns that client information could be used for the benefit of health or life insurance companies or employers who are highly interested in any history of information about your health so that they can protect, manage and assure their own future profits and interests. 

Most managed care companies do not allow individual clients the freedom to choose their doctor or therapists.  Instead, they require you to choose from a list of pre-approved providers.  In the realm of psychotherapy such providers often qualify for managed care panels only if they agree to provide short term care (perhaps as short as one to three private sessions), are willing to accept low fees for services, agree to share confidential client information with the managed care entity, and are willing to give up control of clinical decisions to administrators and CEO’s rather than their own skilled judgment. 

Because of this, I have chosen to work beyond the bounds of the managed care world.  I endeavor to keep my fees as reasonable as possible, in order to provide quality and compassionate services to the men and women of my community. 

In decades past, psychotherapy was a deeply creative, at times radical, re-imagining of human well-being, growth and potential.  Therapists and clients engaged in a rich dance of vulnerable uncertainty, balancing trust and risk-taking in a creative and idiosyncratic push for change, insight and growth.  However today’s therapies are, sadly, far too lacking in such elements.  Rich Simon, editor of Psychotherapy Networker notes, “Today's treatment is more and more shaped by predetermined DSM categories and empirically validated, standardized treatment protocols from which deviation isn’t welcomed, if even tolerated. Part of the reason is, of course, that old bugaboo—the power wielded by insurance companies, who eye any treatment approach or idea that strays off the reservation with deep suspicion or outright rejection. But another part of the problem is that we live in cautious times with heightened concerns about HIPAA guidelines and confidentiality, making it much harder to actually see therapists at work who inspire us to push the boundaries of the familiar and show how to engage clients with a spirit of daring and invention."

My practice is dedicated to a reclamation of what therapeutic counseling was, and again could be:  A radical, compassionate, growth promoting opportunity for individualized personal change, insight and relief from the alienation and neurosis that sadly plagues our experiences in the modern world free from the dictates of corporate and governmental interests.  My clients deserve (and generally demand) no less.

Remember:

Cheaper Is Not Always Better.  Managed care may offer a lower financial cost upfront, but, as outlined above, you may be paying a high price behind the scenes. 

Consider Paying Out-Of-Pocket For Your Psychotherapeutic Counseling.  Your emotional health and well-being is too valuable to leave in the hands of managed care for-profit companies or governmental agencies.  Demand that what you disclose in therapy remains private.

Education.  For additional resources, visit the National Coaltion of Mental Health Providers and Consumers at www.thenationalcoalition.org