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Wednesday, December 26, 2012

Why Has It Become So Hard to Find a Psychotherapist in NYC on Your Managed Care Plan?

Many psychotherapy clients who call me tell me that it's becoming increasingly difficult to find a psychotherapist in NYC, especially if they're trying to find someone in their insurance network.    A big part of the problem is that managed care fees haven't kept up with the overhead that private practice therapists must deal with, so fewer and fewer therapists can afford to take managed care clients if they want to stay in business.  

The Burnout Rate Among Therapists Who Take Primarily Managed Care is High
Therapists, whose practices are primarily managed care, often work very long hours, seeing as many as 35-50 psychotherapist clients per week.  They're usually booked up, and the burnout rate among these therapists is high.  Like many doctors who have a high percentage of managed care clients, some of them are going out of business.

This is not to say that you can never find anyone on your managed care panel, but it's becoming increasingly difficult.

Many Mental Health Managed Care Companies Are Intrusive in the Treatment
The other major problem is that many managed care insurance companies tend to be intrusive in the treatment.  Not only do many of them want to dictate the number of sessions, but some of them want a lot of personal information about what's being discussed in the sessions in order for them to authorize more treatment.  Often, the managed care staff who are authorizing treatment have little to no clinical background, and their decisions are driven by financial rather than clinical considerations.

When a client's managed care insurance is intrusive, it's like having the managed care rep in the room with the therapist and the client.  The therapist must often walk a fine line between preserving the client's confidentiality and giving the insurance company enough information so that they authorize more sessions.

A One-Size Fits All Managed Care Approach Doesn't Work in Mental Health
Some managed care companies have "standards" of what they consider to be the right number of sessions for particular diagnoses.  Even for managed care plans where clients supposedly have "unlimited sessions," the insurance company reserves the right to question the number of sessions based on "medical necessity."  The problem with this is that each client is different and a one-size fits all approach doesn't allow for the uniqueness of each client.  While some clients might get better after  10-25 sessions, it might take other clients that long just to develop a rapport with the therapist and feel a sense of trust.

Managed Care Mental Health Lists Are Often Out of Date
The other problem is that many managed care companies don't update their in network lists very often, so that it appears that they have many more psychotherapists on their lists than they actually do.  When clients go online and call therapists whose names appear on the list, they often discover that the lists are out of date, some therapists have dropped off the list, some are retired and some might even be deceased.

Learn to Advocate for Yourself at Your Workplace
Unfortunately, it appears that this situation won't get better any time soon.  If you have no choice but to go in network and you're having difficulty finding available therapists on the in network panel, you  should advocate with your human resource department or benefits administrator who negotiate contracts with the managed care companies and let them know about these problems.  Most organizations pay a lot of money for health benefits, and they might not be aware of the problems. Your mental health benefits aren't worth very much to you if you can't find a therapist on the list.

If you have out of network benefits and you can afford to pay out of pocket and get reimbursed, you stand a better chance of finding a psychotherapist.

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (212) 726-1006.

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