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Managed Health "Care"

This is a topic that once was simple and now is very complicated.  For individual and family therapy, I have not been cooperating with most managed health care mental health systems for almost two years.  Very briefly (click here for my full length editorial on the unhappy story of managed care), here's why  I haven't been able to  go along:   

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I regret to say that California psychologists have turned out to be no better or worse than the medical doctors when it comes to the Managed Health Care System. Psychologists have, by and large, become employees of the Managed Health Care System. Their loyalties are to the owners of the hands that feed them: The Managed Health Care System Para-professionals (clerks) who send new patients to their offices with pre-qualified numbers of visits. When these patients arrive, the psychologists adjust the fees charged to the insurance company down by about 25% of the 1995 level. That's the good part. The bad part is that the psychologists are required to fill out forms revealing the most intimate details of these "managed" patients' lives, including the intimate habits and behaviors of family members. This information, obtained from clients solely by self-report, is not validated for accuracy before it is returned to the clerks that made the referrals (authorized treatment). When these forms arrive in the clerk's office, they are not only chock full of intimate and personal information, each form is also complete with given client's name, date of birth, address, phone number and Social Security number. No attempt is made to protect the privacy and confidentiality of the patients. To repeat, your identity isn't even protected by a device as simple as omitting your name and using your policyholder number . Nothing "a managed patient" tells a therapist can be safely considered confidential between client and therapist.  Since the clerk works for a contractor who gave the lowest bid to an insurance carrier to "manage" psychotherapy service costs (to do the dirty work of denying benefits), the documentation of the private lives and thoughts of patients isn't even under the direct custody of the major insurance carriers.  Who knows what the clerk does with that information?  Who knows where it will show up next?  You don't have to be paranoid to know it won't disappear.   It might surprise you to know that as a condition of getting your claim paid, you signed a "release form" to let the managed care corporation collect all the information they want from your therapist with no guarantee on that "release form" what will be done with the information.  Click here   to see where the California Department of Insurance directs your complaint about your privacy being invaded by managed care corporations (it seems the CDI has no jurisdiction over health management corporations). You can't even be sure the therapist will tell you the truth when asked about the information he or she is collecting for the Managed Health Care System because some Managed Health Care System mental health contractors will drop the therapist as a provider if he or she reveals any information about the forms the company uses.  Frankly, I don't want to be in an alliance with the managed health care corporations against the best interests of my clients.  There are a few other therapists who agree with this position and are trying to change the laws regulating the managed health care industry.  For the present, it is a very bad system and it makes the most useful therapy impossible.

For the latest on the "Patients Bill of Rights," check out the following link: Patient Bill of Rights? There is more talk than two years ago but no more action. For now, the managed health folks are only being regulated by the honor system.  "Good luck America," a cynic was overheard whispering under his breath.

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[This page last edited on 06/22/07.]  

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On Sabbatical!

When my office lease expired at the end of 2004, I decided to turn it into a "sabbatical" from my private practice. Many years ago, in my grandfather's 89th year of life, he told me, "John, it is important to smell the roses while you can still smell them." His life gave living a very good reputation. It is also true that the pursuit of that philosophy required my grandfather to to re-open his assay office/ore market in Wickenburg, Arizona as a 75-year-old because he had run a little short of retirement money. Thus, if blessed with his luck and health, I'll be back.. --jjh

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