Many of you already know either through personal experience or through the media the limitations of insurance companies managing mental health benefits.

Briefly: your choice of therapists is limited because you will have to pick one from their list not yours. As with your Family physician, it does not matter that you already have established a working relationship. Providers who enlist with an HMO are referred to as "in network providers". These are Therapists who have been contracted by the Insurance Companies on a consultant basis to work with clients for less money in return for the promise of a steadier flow of referrals. Usually these contracts contain a variety of limitations to doing therapy. Therapists are required to justify working with their clients beyond establishing a diagnoses by submitting so-called outpatient treatment reports on an ongoing basis, and so giving out often intimate details of your life in order to get more sessions approved.

By being reqired to work closely with the insurance company confidentiality is compromised. Therapists may be very carefull and conscientious about what they reveal to your insurance company but your signature gives them complete access to your medical file. They may also try to determine the "type" of therapy you need regardless of your preference. And of course most companies state explicitly that they require a limited number of sessions regardless of what is medically necessary.

Moreover, most insurance companies will not pay for marriage counseling or family counseling.

Still many of the demands that HMO's are placing on Health Professionals are not all bad ones. They help to reduce fraud and unnecessary treatment.

Many years ago insurance was just that: it insured the family against catastrophic losses. It was designed to help individuals or families where an illness, if treated, would render the family penniless.

Families were expected to pay a certain percentage out of pocket and then insurance would step in. Over the years things have changed as more companies increased available benefits such as dental, wellness, vision and so on, as a hiring incentive when there were considreably more jobs available than qualified people to work them. "Free" health care became more and more an expected entitlement. A lot of people got an inflated sense of what they could expect. Consequently individuals seem to feel less and less responible for their healthcare cost. Medical costs and premiums sky-rocketed and things got out of control. Now, the main emphasis of managed care is cost reduction, not your well-being.

Hopefully HMO's are a temporary stop-gap measure until a more ethical and moral way is found to fund health care.

Some of the things that we can do to help this process along is to return to some old fashion values and take control of our own lives.

We need to question if we as adults are "entitled" to anything. Are we willing to take responsibility for our own health and health care? Insurance is for catastrophic life-threatening, income-threatening illness. After insurance has made sure that you can "go to work, not be a danger to yourself or others," it would seem that it has met its part of the bargain. They care that you live, but it is up to you to care about the quality of your life.

Quality mental health care is our primary focus since good mental health leads to a richer quality of life.

The Red Model

If you want to continue psychotherapy after managed care has decided to end its responsibility, talk to your individual therapist about cost alternatives available to YOU. In doing so, we can guarantee confidentiality and draw from a wide range of treatment modalities that best fit your needs. In addition, the duration of treatment and cost of your therapy is decided in consultation with YOU and the therapist of your choice. If there is anything we can help you with please don't hesitate to ask. Your mental health is a team effort.

For further information on managed care click here.