Managed Mental Health Care (MMHC) has become a reality for many. It can  make it difficult always to find a therapist of choice. Not all therapists are on all "panels" --that is, to be eligible for insurance coverage two things must be true: (a) You have an insurance policy that provides mental health benefits, and (b) the therapist you wish to choose must be among the providers your policy will cover. Not only is there considerable paper work required of the providers on the panel, but there are numerous restrictions imposed as well (for example, number of sessions, types of treatment, etc.). Some providers simply refuse to submit to the process of getting approval for service. Nor is service only available if one has insurance coverage: people do cover their own treatment expenses.

On the other side of the coin, today there is considerable emphasis placed on results. MMHC companies want assurances that treatments they pay for will be effective. (Measuring effectiveness, beyond consumer satisfaction, is an ongoing issue among psychologists.) Thus, MMHC is spearheading a movement that emphasizes accountability. Whether they are going about it in the best and most humane fashion is still to be decided. But today in a number of quarters there is great interest in developing treatments that work.

I am on a number of panels (see my Services) and therefore can receive payments from these carriers. The following is a list of questions that I would urge everyone to ask of their MMHC carrier.

 

Questions to Ask a Managed Care Company 1. Check the plan brochure for your mental health benefit limits (for example, either $2,000 outpatient coverage over a two year period or a certain number of days per year). Check what the benefit limits are for drug & alcohol treatment. 2. Ask who is in charge of deciding how many treatment sessions are needed. Is it you, the client? Is it the therapist you choose? The therapist the company chooses? Or person(s) in the managed care company's administrative office? 3. Ask your insurance company what is the usual (not average) number of sessions allowed for an episode of mental health treatment? 4. Ask if your therapist would have to request authorization for treatment? & How often (every 5 visits?, etc.) a reauthorization request is needed? 5. What information about you must he disclosed in order for there to be an authorization for treatment? How is the confidentiality of that information treated? 6. Ask how many mental health providers are on their staff or panel(s). What are the qualifications of those providers? What is the ratio of providers to the number of insured persons? Ask  for the proportions of social workers, psychologists, counselors, and psychiatrists that comprise the company's mental health providers. 7. How many mental health practitioners are on their utilization review" committee the group  that makes the decisions whether to authorize continuing treatment)? How often does it meet?  What is the average time spent reviewing each case?  Ask for the qualifications of the people on the panel if they are not mental health  practitioners. 8. Ask whether the company has published standards of care for mental health diagnoses. And whether those are based on clinical research? 9. Ask what mental health diagnoses or disorders the plan or insurance does not cover. 10. Ask if the mental health providers work under a fee for service system where they are paid for the services they provide? Or a capitation system where their income is in part dependent on limiting the amounts of treatment they provide? 11. Ask if you, the client, can continue to work with your counselor, social worker, psychologist,  or psychiatrist when insurance covered treatment ends by paying for that continued treatment; out of your own pocket? 12. Ask what is their procedure for client complaints? For appeals for extension of treatment?  Ask that the appeals process be explained clearly. Ask who are the members of the appeals panel (what type of professionals). If you have concerns about the type of services you are eligible to receive, express those concerns to your human services department where you work, or to who ever arranges for the insurance contracts and benefits for your company.

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