Behavioral/Mental Health Managed Care

One third of Americans will suffer from a mental health condition within their lifetime. Managed care companies have made many of their cuts in the area of mental health care coverage.

Patients in need of mental health care are a part of a vulnerable population that has problems dealing with their emotions, may be too embarrassed or incapable of speaking out against managed care problems, and thus, are forced to stay with a plan that they are unhappy with.

Managed care plans usually limit the number of sessions that a patient can have, when indeed a patient may need extensive therapy in order to get well. Issues of privacy/confidentiality arise when these patients are no longer guaranteed that the mental health professional is the only individual with access to records and personal information. Also, managed care plans abruptly terminate treatment if patients do not show significant improvement after a few sessions with their therapists. Finally, treatment options outside of what the patients’ plans cover are not provided to patients, thus these patients may not be aware of potential effective treatments.

For mental health professionals, capitated rates pose a problem because of the variety of patients they deal with. Some patients may only require a few treatment sessions whereas other patients may require many more. Thus, mental health professionals feel that they are not paid as they should be.

My goal is to provide links to websites and documents that provide viewpoints of mental health professionals and resources for patients when dealing with managed care.

WEBSITES

1. National Coalition of Mental Health Professionals & Consumers, Inc.

http://www.nomanagedcare.org

This coalition consists of professionals, consumers and consumer advocates within the mental health field. This site focuses primarily on the problems managed care has posed for mental health patients and professionals. The main goals of this association are to 1) expose the problems of managed care 2) regulate the managed care industry 3) promote alternatives that allow patients’ rights to be maintained. This site is very informative, provides good resources and articles related to the problems of managed care in mental health. Rating (*****)


2. California Coalition for Ethical Mental Health Care

http://www.ccemhc.org/

The main goals of this organization are to "preserve the quality, integrity and confidentiality of mental health care through public and professional education and legal and legislative action". This site is geared towards mental health patients, professionals and consumer advocates. The most relevant section of this website is the Newsletter Archives section which includes previous articles on managed care myths, federal response to managed care, issues of patient confidentiality and recommendations for state regulation of the managed mental health care industry. Rating (****)
3. Citizens for the "Right to Know"

http://www.rtk.org

The primary goal of this organization is requiring health service organizations and insurers to provide information on benefits and coverage to consumers and education for enrollees in health care plans. This site provides a section, about managed care that includes the history of managed care, problems with managed care and this organization’s role in managed care reform. Other informative sections include the section on choosing a health plan which provides tips when deciding between different health plans and questions to ask health care companies, the glossary of terms section and the section, health plan problems? discusses patient rights and filing complaints. This site is excellent for every patient, including those who have limited knowledge about the current managed care system. Rating (****)
4. American Psychological Association

http://www.apa.org

This website contains a search section entitled ‘What are you looking for’. When ‘Managed Care’ is typed in, over 300 documents relating to behavioral health and

managed care published in the APA Monitor and other journals relating to are shown. This website is great source of information when it comes to finding documents related to behavioral health and managed care. Rating (****)

5. A Solo Psychiatrist Fights Managed Care
http://pw2.netcom.com/~mvp1/soloproviders1.htm This website was created by Dr. Marcio Pinheiro, M.D., who is a practicing psychiatrist and an advocate of patient and physician rights. This site is dedicated to exposing the problems of managed care. The most relevant sections of this site contain interesting articles and his and his patients’ personal experiences with managed care. Rating (***) DOCUMENTS

1. Eleven Unethical Managed Care Practices Every Patient Should Know About
(With Emphasis on Mental Health Care)

http://www.nomanagedcare.org/eleven.html

Written by Ivan Miller, Ph.D. in August of 1998, this document contains unethical practices by managed care companies. The article’s main thesis is that while trying to cut costs, managed care companies are paying regard to practices that may be unethical. It provides in-depth detail of what rights patients have and what rights are being violated by managed care companies. This document also has sections on Managed Care Excuses for Unethical Practices and What Can the Consumer Do?Rating (*****)
2. The Powerful Patient Mental Health Coverage. Find Out What Your

Health Plan Offers—Before You Need Treatment

http://www.thriveonline.com/health/powerful/insurance.mental.html

This document provides useful guidelines and tips for mental health patients before choosing a health plan, such as what benefits are included, professionals the plan covers, treatments offered and other important questions to ask health care plans. It also provides a link to Mental Health Bill of Rights.

This is a great document for patients and families of mental health patients when choosing an appropriate plan. Rating (****)

3. Two APA Members Sue Managed Care Companies on Behalf of Patient  Welfare. Lawsuits aim to force greater accountability.

http://www.apa.org/monitor/feb00/suits.html

This article is from the APA’s magazine, The APA Monitor. Vol.31, No.2 Feb.2000. Author: Lisa Rabasca

This article discusses two separate lawsuits filed against managed care companies. The first lawsuit involves a psychologist who was terminated from Aetna USHC because he refused to provide confidential information to the company about a patient that he was treating. The second lawsuit was filed by another psychologist, against Magellan because the company abruptly discontinued a patient’s mental health coverage even though the psychologist alleged it would be harmful for the patient’s well-being if treatment would be terminated. This article provides good examples of what mental health professionals go through when dealing with managed care companies.

Rating (****)

4. Health plans continue to limit mental health benefits, study finds.

http://www.apa.org/monitor/julaug99/n18.html

This article is from the APA’s magazine, The APA Monitor. Vol.30, No. 7

Jul/Aug.1999. Author: Lisa Rabasca

This article presents the results of a study done by an actuarial and benefits consulting firm. It states that health plans that are employer-sponsored are setting a limit on the time patients can be hospitalized for mental illness and the number of psychotherapy sessions. This study also found that the value of behavioral health care benefits decreased by 1.5% from 1997-1998. Additional statistics are given on the cuts in behavioral health care benefits. This article is another example of numerous findings that behavioral/mental health benefits are being cut. Rating (***)

5. "I’ll Say I’m Suicidal". The mentally ill struggle through the maze of managed care.

http://www.usnews.com/usnews/issue/980119/19mana.htm

This article was published in U.S. News. Jan. 19, 1998. Author: Susan Brink

This article presents the story of a patient with manic depression who went to her hospital two times after having symptoms, and was told to go home by her managed care company whom doctors contacted when she arrived. When she attempted suicide soon after, she was finally admitted. It also presents the on-going problems of managed care companies, statistics of a decrease in therapy sessions covered by plans and problems with getting adequate care. This article is yet another example of a patient who had difficulty getting proper care and treatment due to her managed care company’s policy. Rating (***)
 
 
 
Note: The information below may contain additional relevant materials and documents. Some of the information may be duplicate. The evaluations depend on both the student doing the review and the information contained at the time of the review. Sites are subject to change!