Academic journal article Journal of Mental Health Counseling

Dealing Constructively with Managed Care: Suggestions from an Insider

Academic journal article Journal of Mental Health Counseling

Dealing Constructively with Managed Care: Suggestions from an Insider

Article excerpt

The author, a former mental health counselor and managed-care case manager, offers suggestions about dealing constructively with managed care organizations. Specific suggestions concern how mental health counselors can develop working relationships with case managers, do treatment planning, submit claim forms, and resolve disputes.

Managed mental health care has changed the way mental health counselors perform their clinical duties. There is an increased emphasis on demonstrating the efficacy of mental health services while containing costs. As a result, writing treatment plans and doing concurrent reviews are now familiar activities for the mental health counselor. Administrative issues such as filing insurance claim forms are another requirement of managed care. Unfortunately, training programs have not taught the skills mental health counselors need to successfully negotiate the managed care process (Cummings & Hayes, 1996; Cummings, Budman, & Thomas 1998).

There is evidence to suggest that training programs are changing to include information about managed care (Smith, 1999). New curricula have been devised (Donovan, Steinberg, & Sabin, 1994; Patterson, McIntosh-Koontz, Baron, & Bischoff, 1997). Information is available that suggests the knowledge mental health counselors need in order to work successfully with managed care (Lawless, Ginter, & Kelly, 1999). Specific information about how mental health counselors can negotiate the managed care process is lacking. This article is an attempt to remedy that.

The author is a former mental health counselor and managed care case manager. This article offers suggestions to mental health counselors so they can deal constructively with managed care organizations. Specific suggestions are offered on how mental health counselors can develop working relationships with case managers, do treatment planning, submit claim forms, and resolve disputes. While there has been information presented on what questions providers should ask themselves before contracting with a managed care company (Tuttle, 1991), the present article is addressed to mental health counselors who are already contracting with managed care companies.

DEVELOPING WORKING RELATIONSHIPS WITH CASE MANAGERS

The importance of the relationship between the mental health counselor and the case manager cannot be understated. A positive working relationship between these two professionals can make the managed care process run smoothly. A negative working relationship can be frustrating for both parties. In the early days of managed care, adversarial and hostile relationships between providers and case managers were common (Schreter, Sharfstein, & Schreter, 1994). Fortunately, there are things the mental health counselor can do to develop a positive working relationship with the case manager.

The relationship between the mental health counselor and the case manager is unique. All of the communication between these two parties is either done by writing or telephone. The case manager is responsible for making reimbursement decisions about clients' treatment without ever seeing them. As a result, the mental health counselor must give accurate clinical information about the clients' treatment to the case manager. As a network provider, the mental health counselor must also adhere to the managed care company's clinical guidelines. The ability to accomplish these tasks as efficiently as possible is very helpful.

One of the important things for the mental health counselor to remember is the case manager is not the enemy. The case manager wants clients to get better just as much as anyone. In order for this to happen, the case manager needs to have specific information about what is being done for clients and why it is being done. This includes current symptoms the client is experiencing, what interventions have been tried in the past, success or failure of these interventions as well as the goals and objectives for treatment. …

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