Psychotherapists work outside of managed care system

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(Host) Critics of managed care health coverage say a growing number of psychotherapists in Vermont and around the country are refusing to take patients covered by managed care.

Instead they’re asking patients to pay out of their own pockets, as VPR’s Steve Zind reports:

(Zind) Ivan Miller says therapists nationwide are rising up against managed care health insurance plans. Miller is one of a group of Boulder, Colorado psychotherapists who refuse to take patients covered by managed care insurance plans. He estimates that nationwide 30% of psychotherapists have opted out of the managed care system, and he says the number is growing.

Miller says that’s because mental health treatment has absorbed a disproportionate share of cuts at the hands of managed care:

(Miller) “It’s just been devastating how bad they’ve hit the field. They’ve cut back mental health care seven times as much as physical health care.”

(Zind) Miller’s patients pay for their therapy out of their own pockets. He says that gives them more choices, more control over their treatment – and better treatment than they get under managed care. Because mental health care is a lot less expensive than hospital care, he says paying for services is a reasonable alternative for many people.

Managed care plans have come under fire from consumers and the medical profession for the methods they use to control costs. People with mental health coverage are often required to use a therapist from a pre-approved list. In many cases, the benefits cover only a set number of visits.

Miller says therapists in managed care systems are underpaid, overburdened with paperwork, and pressured to keep costs down. He says the result is substandard care.

(Miller) “I don’t want to see a burned out, overworked, underpaid professional.”

(Zind) Dr. Robert Emmons agrees that the managed care approach to mental health treatment doesn’t work. Emmons is a Burlington psychotherapist. He says another drawback of managed care is that a therapist has to share a patient’s records with the insurance company.

(Emmons) “If patients know information is leaving the room, if they know a report is being sent off, they’ll say less. I think if any medical treatment, but especially in psychotherapy, if you don’t feel free to say everything, then the treatment isn’t as effective.”

(Zind) Emmons says he recently surveyed Burlington psychiatrists and found that a third of them no longer deal with managed care providers. He’s one of them.

According to the Health Department, more than 50% of Vermonters who are privately insured are enrolled in some sort of managed care system. Karen Ignagni is president of the Washington-based American Association of Health Plans which represents health insurance providers.

Ignagni says businesses providing health insurance for their employees have to look at the bigger picture of providing health care coverage that’s as comprehensive as possible and still affordable. That requires setting some limits to mental health coverage. And Ignagni says psychotherapists like Miller and Emmons are trying to return mental health care to the days when there was no accountability.

(Ignagni) “Looking at the data about the explosion of visits that occurred ten years ago on the mental health side, employers have tried to provide access to health care but at the same time tried to prevent the over utilization that was going on in the profession.”

(Zind) Ignagni says the mental health system and therapists should submit to treatment guidelines similar to those used for physical illnesses. But Miller and Emmons say that’s a one-size-fits-all approach that doesn’t work for therapy.

Not all therapists are opting out of managed care. Harvey Liss is a Brattleboro psychotherapist. Liss says he’s still able to do his job under managed care, but it’s harder.

(Liss) “In some cases, the therapy can go along much the same as it would in the past. In other cases, the therapist can feel a lot of pressure to work within the guidelines of the insurance company. Especially with clients who have more severe or long term needs, that becomes more of an issue.”

(Zind) Since managed care plans differ, Emmons and Miller say it’s important to know the specifics about their mental health provisions before deciding whether to use the coverage, or pay out of pocket for mental health care.

For Vermont Public Radio, I’m Steve Zind.

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