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                                                              DR. Michael Shery, clinical psychology

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Getting Mental Health Services thru Your Managed Care Plan

 

By Dr Mike Shery

 

Sometimes accessing the mental health, psychiatric, counseling or psychological services to which you’re entitled can seem like a daunting task.

First, it’s important to understand some definitions. A managed care format is one where, to be eligible for the mental health benefits, your insurance company   must actually supervise by authorizing the type, frequency and intensity of the care you receive.

 

Your psychologist or psychiatrist actually calls your plan’s case management department, describes your situation and then gets approval to render outpatient psychotherapy to you for a certain number of times at a particular frequency. For example, your psychologist may obtain approval for you to receive 8 psychotherapy sessions, once per week. The case manager at the insurance company makes the decision as to what to approve after listening to your doctor’s analysis as to what’s appropriate. The case manager, however, makes the final decision, often agreeing with your doctor but sometimes compromising or even suggesting alternatives to the doctor’s recommendations.

 

What specific services are required to be authorized for your plan to pay vary according to your policy. The strictest ones require all services to be authorized, including inpatient and outpatient psychotherapy and psychological testing. The profile of services requiring pre-authorization may take any form, including the requirement that you, the patient, talk to a case manager to get approval before your doctor calls; sometimes the case manager will only talk to you, without the doctor needing to call at all. Others may require only in-patient services to be authorized, while others may also mandate that out-patient psychological testing be pre-authorized. There is no limit to the variations in requirements for pre-authorizations required by these plans.

 

Preferred provider organizations (PPOs) will have a provider directory or a mental health provider directory and require that you be treated by someone listed there, one of “their” preferred providers to qualify for them paying for your services. Mental health and psychologist preferred providers are often listed in your PPO’s hard copy or internet provider directory.

 

Some managed care plans requiring the use of preferred providers include: ValueOptions, Cigna, Medicare, Cigna Behavioral Health, United Health Care, Aetna, First Health, Healthstar, Blue Cross Blue Shield of Illinois, ComPsych, Magellan Health, HFN, Tricare, Humana, most union local plans, most school district plans, Unicare, ChoiceCare, CAPP, Multiplan, Mental Health Network, Managed Health Network, United Behavioral Health and Beech Street.

 

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