The Carnival of Managed Care: How it Compromises Your Mental Health

Do you think that, after months (maybe years) of hemming and hawing about the time and cost and need of going and finally deciding to actually give yourself the gift of self-care and receive professional care, do you think it is YOU who decides if you can go and use the insurance that YOU PAY FOR?


I could be blogging about steps to help overcome depression, postpartum depression, generalized anxiety, obsessive-compulsive disorder, any number of mental health diagnoses in which I have been trained. But I have decided to blog about managed healthcare insurance a few times, just so you have an understanding of what goes on behind the scenes.


Do you know who determines if you are allowed see a mental health professional? For the first few sessions, well, I need to ask permission to see you from the clerical staff at managed care who completes authorizations. You can get a whole six, yes count ’em, six sessions to start with. Your husband is abusive? Sexual or age discrimination at your workplace? Well, you get six sessions. You feel depressed from a convergence of a multitude of issues? Perhaps past abuse? Rape? Gang rape? Post-traumatic stress disorder from a shooting? PTSD from multiple medical procedures (even if warranted and life-saving, this is common). Your child has leukemia?


Well, you get six sessions. TAKE ‘EM OR LEAVE ‘EM.


What’s the matter? You need to talk more? You need more treatment? MORE??


Sounds Dickensian…you want some more OF THE SERVICES YOU PAY FOR!!


Well, okay, then there is the continual authorization renewal process.


I want to let you know what this is like. I need to take time during my clinical hours to hold on the phone for usually about 30 minutes, sometime less, ofter more, to wait for the honor of speaking to a Care Manager.


During this conversation, the Care Manager ask me invasive questions about YOUR LIFE and then judges me on my clinical expertise.


Then, the Care Manager judges me on how well I have been trained like a dancing bear to play their game. The managed care insurance company sets up rules where a certain type of treatment MIGHT be acceptable. And others are not. Did you know there are course on how to give managed care the answers they want? I won’t take one of these courses. I won’t spend my hard-earned money on this nonsensical game.


If I say the right thing, DING! Like at a carnival, DING! You get more sessions (MAYBE).


If DING, I say the WRONG thing, DING! You are denied. (LOL -No sessions for you, says the insurance Nazi ..like Seinfeld’s Soup Nazi…this is a joke)


But, let’s face it, after a few authorizations, not even the right words help.


So, DING the case gets escalated to a managed-care psychiatrist. And then I need to make an appointment during my clinical hours to speak to this disembodied person on the phone, who again asks MORE invasive questions about a client that he has never met and never will. And then I am judged again.


Is this the way other people get paid?

Are your paychecks held back unless you answer the questions correctly EVEN AFTER YOU’VE DONE YOUR JOB????


But you know, you, the client, are the loser in this game.


Oh, well, guess you’d better go to a relationship coach about your marriage. You can’t continue to see your therapist, with whom you have a therapeutic bond that has developed over a long period of time.


What to do? The response of the therapeutic industry has been to become more facile and to offer programs outside of insurance. Stay tuned to this blog for new programs. Thanks!