Manage Your Own Care by Using a Private or "Out of Pocket" Payment Option
Many people assume that using their insurance benefits to pay for counseling services is their best and most economical option. However this is no longer true in many cases. Increasingly people are opting out of “Managed Care” and choosing to pay privately for the counseling services of their choice. Proponents of Private Pay or ” Out of Pocket” payments for counseling services cite several very good reasons for breaking free of managed care. They have to do with possible conflicts of interest, therapy restrictions, diagnostic labels and stigma, wasted time and concerns regarding privacy and confidentiality. (I have included a more lengthy explanation of these issues at the bottom of this page if you wish to take the time to review them.)
I personally believe that paying privately “out of pocket” for counseling is the best way to insure your privacy as well as get the type of services best suited to your specific needs. My preference is to avoid dealing with Managed Care companies all together and work directly with my clients.
However, I also understand that many people feel compelled to use insurance benefits if they have them. For that reason I offer both Private Pay and Insurance Pay options for my clients. I have structured my fees to be fair and reasonable for those choosing to pay “Out of Pocket” for the counseling services of their choice. My fees are located under the Services tab.
Reasons to Avoid Managed Care
Conflicts of Interest
Professional Counselors are ethically required to avoid potential conflicts of interest. The counselor’s primary concern needs to be for the 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. Managed care companies were created to “manage” and contain escalating health care costs. Their bottom line is to reduce costs and raise profits; it is not to increase the quality of care or quality of life for their members. When contracted with an insurance company, a therapist is legally obligated to follow the company’s rules in order to get paid and continue getting referrals. For example, if a counselor provides service to a client and then is denied payment by the insurance company due to it not being a “clean claim”; meaning everything done and perfectly according to the company’s specification, then the therapist can’t bill the client for those services. The service provider just doesn’t get paid. This conflict of interest is a very difficult position to be in and many are choosing to avoid it all together by avoiding managed care.
Restricted Choice
Often managed care companies restrict the client’s choice of therapist and therapy by only contracting with therapists who offer short term or brief therapy. Such therapy meets the financial criteria of managed care companies but may fail to afford clients the opportunity to get the more in depth services that they really need and want. Quality of care is of course compromised when a client’s needs go unmet due to an insurance company’s financial bottom line. Managed care companies can 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. Client centered therapists believe that clients should be able to access a wide range of therapists who practice from a variety of therapeutic modalities so they can make informed choices and work with the therapist that is best suited to meet their particular needs.
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 some type of mental illness be placed on clients in order for them to access their mental health benefits and pay for needed treatment. Often times this diagnosis is to be made by the mental health professional during the precertification process or very early on in the provider client working relationship. While it may only take a moment for a diagnosis to be cited in a precert process so that a client can access their mental health benefits; that diagnostic label can last a lifetime on the insurance company records. Many people who might benefit from therapy do not fit into a clear diagnostic category. Likewise, they do not wish to put on a label of mental illness with its associated stigma just for engaging in a process of healing and growth. Many clients are looking to improve the quality of their lives via prevention, exploration, education, personal growth and healing rather than simply surviving a diagnosable mental illness or specific life crisis.
Time
Managed care companies usually require therapists to justify and convince Utilization Review professionals that therapy is needed before it can be authorized or pre certified and then again if it needs to be continued. This is an extremely time consuming and delays in the utilization review process often trigger increased anxiety in clients. Likewise they can cause therapy to follow according to managed care driven “fits and starts” rather than proceed seamlessly according to the patient’s personal treatment plan.
Privacy and Confidentiality
While all insurance companies have privacy policies, the use of your insurance benefits to pay for therapy in and of itself limits your privacy. Diagnostic codes are attached to medical bills which can be seen and understood by those working in your employer’s human resources department. Likewise, the precertification and utilization review processes of managed care companies themselves drastically reduce the privacy of your personal information. Deeply personal information must be shared with insurance company “gate keepers” and utilization review professionals in order access your insurance benefits and authorize your chosen trtreatment. By the end of a treatment episode, literally dozens of insurance company employees have had access to your personal,private information.