Providing therapy when managed care organizations deny reimbursement: are private practitioners and their clients taking the fall?
Sampled private practitioners from the Register of Clinical Social Workers, American Psychological and Psychiatric Associations were used to evaluate what percentage of these practitioners' caseloads are made up of clients who have been denied reimbursement by managed care organizations for ongoing therapy. The results indicate that 39% of the respondents' caseloads are of managed care insured clients, of whom nearly one-third have been denied reimbursement for ongoing therapy, and of whom 42% later reenter therapy with an acute exacerbation of symptoms. The results have potential ethical and legal complications for private practitioners treating clients insured by managed care organizations.
Keefe
Robert H
RH
School of Social Work, College of Human Services and Health Professions, Sims Hall, Syracuse University, Syracuse, NY 13244-1230, USA. rhkeefe@social.syr.edu
Hall
Michael L
ML
Corvo
Kenneth N
KN
D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008297:Male; D008329:Managed Care Programs; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008875:Middle Aged; D020399:Practice Management; D011613:Psychotherapy / Q000191:economics*; D012008:Recurrence; D012947:Social Work / Q000191:economics*; D014481:United States