What Are the Pros & Cons of Managed Care Involvement in Mental Health Professions?

Mental health services' involvement with managed care companies has its positive and negative sides, for both the clinical provider and patient. Managed care services direct the type of mental health care that is needed, what level of care is necessary and how long a person will need the services.

Function

• Providing services as a mental health clinician for managed care companies includes applying to become a provider and developing a contract. Once a provider, patient members can obtain services from the clinician that the managed care company will reimburse.

Provider Advantages

• Working as a clinician for a managed care company allows for easy access to patient referrals, reliable reimbursement for services rendered and access to resources such as continuing education seminars and peer consultation.

Provider Disadvantages

• Assuming a role as a clinician working with a managed care company requires time to adhere to billing and processing procedures, which may incur additional costs. Negotiated reimbursement rates with managed care are usually lower than out-of-pocket rates.

Patient Advantages

• Accessing referrals to mental health clinicians as a patient is easily done by calling the managed care company or looking up providers on the company website. Clinical providers are held to high ethics and standards of care when contracted with managed care companies.

Patient Disadvantages

• Using services through behavioral health managed care allows for the company to determine how much service is needed and what will be paid for. Once mental health benefits have been used it may be difficult to obtain managed care insurance in the future due to the preexisting condition.