NEW YORK _ Managed-care companies have several names for
what's ailing people who spend years in psychotherapy that the
companies consider unproductive: they call it the New Yorker
syndrome or the Woody Allen syndrome. And they intend to
But who determines whether psychiatric treatment is productive
or merely high-cost self-improvement? This question has led to
pitched battles between the companies and psychotherapists,
particularly in the New York region, where more than 20 percent
of the nation's therapists work.
The battle is seen as a testing ground for the efforts of
managed-care companies to scrutinize more closely medical
spending in New York, where managed care has been slow to take
Many therapists say managed-care companies, intent on cutting
costs, are undermining the quality of care by calling the shots
on treatment without ever seeing a patient. These companies, they
say, favor doctors who charge the lowest fees, driving some
practitioners from the profession.
"This industry is destroying the field," said Dr. Karen Shore,
a psychologist and co-chairwoman of the Coalition of Mental
Health Professionals and Consumers, a Long Island-based national
group that opposes managed care for mental health. "Nobody wants
their kid to be a psychologist anymore."
Managed-care companies and their advocates, who include some
psychiatrists, counter that therapists are chiefly unhappy about
the loss of income. Insurance plans have never been very generous
with mental health care, but the managed-care companies are even
In the New York area, typical therapy fees range from $150 to
$300 an hour for a psychiatrist and from $40 to $150 an hour for
a social worker, but managed-care companies generally pay only 55
to 60 percent of that. One doctor said he was getting $80 a visit
from managed-care companies but usually charged twice that;
another was asked to settle for $40.
Supporters of managed care say many practitioners would rather
keep people in talk therapy for years than try drug therapy that
has increasingly proven effective. For years, these doctors had
authority to continue treatment that shows no signs of working,
the companies say.
"There's a lot of resistance against managed care among
psychiatrists because they don't want to be part of a system
where they have to conform to what the company's rules are," said
Dr. Terry Golash, medical director for Empire Blue Cross/Blue
Shield, who has both supervised managed-care reviewers and been
subject to their scrutiny in his private practice. "A lot of
doctors don't like to call and ask for permission."
Dr. Ian Shaffer, executive vice president and chief medical
officer of Value Behavioral Health, the country's largest
managed-care company, argued that patients can suffer when their
doctors' decisions go unchallenged.
But therapists say patients suffer when their professional
judgements are challenged by sometimes unqualified employees of
managed-care companies who press them for confidential
Psychiatrists also complain that they are increasingly limited
to dispensing pills as therapy is conducted more and more by
licensed social workers or psychiatric nurses who charge lower
fees. Psychologists say they, too, are being shunned, and many
are leaving private practice for diagnostic and consulting work
in schools and businesses.
One Manhattan psychoanalyst said those in his line of work are
"an endangered species."
Most managed mental health care companies report that they
deny a very small number of requests for treatment. Value
Behavioral Health, for example, has an outright denial rate of
less than 1 percent.
But reviewers and providers commonly negotiate agreements that
provide less treatment than the therapists originally requested,
Golash said. …