Why I prefer to work as an Out Of Network Provider

Reasons Why I Do Not Work With Managed Care Companies

My practice is solution- focused on quality of life and personal goals. My work with clients focuses on prevention, exploration, and personal growth rather than simply survival. We typically talk in terms of possibility and resourcefulness, gratitude and integrity, commitment and personal responsibility.

Working with managed care companies is not a choice that I can ethically make. Why you ask….

Privacy / Confidentiality

By contracting with managed care companies, it is likely that I would be required to share my client’s deeply personal information with gatekeepers and utilization review professionals; it would mean potentially allowing literally hundreds of other to have access to my client’s personal information.

Diagnosis and Stigma

Managed care companies typically cover only those services deemed medically necessary which is defined as being literally about life and death and the treatment of illness. This means that they require a diagnosis of mental illness in order for you to get reimbursed for any counseling that you engage in.

Furthermore, when submitting a claim to your health insurance, you permit your provider to provide the clinical information that the insurance company requires to substantiate the medical necessity of your care. Thus, your diagnosis and sometimes the supporting evidence for that diagnosis becomes part of your health record. This could affect your ability to get life insurance in the future. It could potentially impact other areas of your life that take your health record into account. Since the passage of the Affordable Care Act, for now it is more difficult for future insurance companies to use your health record as a way to deny future insurance coverage because of a pre-existing condition, but this may change again in the future. Whatever the case, a diagnosis will stay on their record for life.

Conflicts of Interest

As a Licensed Professional Counselor, I am required to avoid potential conflicts of interest. My primary concern is for my client’s well-being. Therapists working under the constraints of managed care companies are sometimes put in the position of having to choose between what is in their own best interest and what is in their client’s best interest. I do not want to be put in that position.

Restricted Choice

Often managed care companies restrict the client’s choice of therapist by offering only short-term / brief therapy. Such therapy meets the financial criteria of managed care companies but may fail to afford my client the opportunity to get the information / therapy that s/he wants / needs.

It is my belief that this often results in my client’s quality of care being compromised. And, this, of course, can result in the possibility of my client’s needs going unmet.

Managed care companies may choose to limit what therapies are offered, can restrict what is discussed in therapy, and decide which clients can be seen and for how long. Some managed care companies have even included “gag clauses” in their contracts to prevent therapists from suggesting more effective treatments.

Professional Expertise

I believe that my clients should be able to access the full range of mental health professionals according to their needs.

Often managed care companies restrict the professionals that clients are allowed to work with – preferring to refer clients to therapists who have a record of providing short-term therapy rather than to other therapists who may provide better results or offer a different packaging of services.

Contractual Limitations

I believe that a client has the right to full disclosure of any arrangements, agreements, contracts, or restrictions between any third party and me that could interfere with or impact your treatment.

Managed care companies may label counselors’ choices to advocate for clients in this manner as “Managed Care Unfriendly Behaviors” and take such actions as they deem fit.

Typically “violations” such as these result in therapists being removed from provider panels or censored in other ways.

Medication

Research has consistently shown that medication for problems with mood is most effective when combined with psychotherapy. Nevertheless, managed care companies frequently approve medication only for their members rather than permitting them to also work with a mental health counselor.

Again, the appearance is that of being more concerned about money rather than my client’s needs.

Time

Managed care companies usually require therapists to justify and convince Utilization Review professionals before treatment is approved / continued. This is time-consuming for the therapist and for the client who is required to continue his / her therapy in “fits and starts.”