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My Progress Toward Breaking Free of Managed Care

07/12/11
By Joan Normandy-Dolberg, LPC, Chair Public Awareness, Advocacy, and Marketing Committee

In the April Counseling Tips, I discussed my dilemma about remaining a managed-care provider, and I promised to update you on my decision and my progress toward breaking free of managed care. 

While I was wavering and getting my courage up, I hired a billing company to examine my books and attempt to collect my outstanding accounts receivable. Imagine my surprise when I found out that our small group of seven clinicians has almost 600 outstanding claims, totaling almost $45,000 in lost revenue in the last year—most from managed care! 

These numbers were a rude awakening and pushed me over the edge, and so I decided to go off managed care.

The next step was to write an official resignation letter to the companies with which I participate. On Feb. 23 I wrote, faxed, and mailed my letters. I waited two months for a response, and when on April 25 I received a message on my answering machine from one of the largest national companies, I was informed that I could not go off their list unless our entire group also resigned! Several phone calls and untold aggravation later, I finally reached an individual who could help me understand how I could resign without affecting the other clinicians. Unfortunately, first I had to rescind my initial letter and start the entire process over again.

When the managed-care representative I spoke with wanted to know why I decided to leave, I explained that the average fee for service in my area (suburban DC) is $100–125 per visit, while their reimbursement is $64. I am also tired of the poor service they provide. It is not unusual for my administrative assistant to be kept on hold for 30 minutes while the managed-care company determines a client’s benefits. Once she reaches a “live” person, the service isn’t much better—the representative often refuses to check benefits for more than one client. Obviously our time is not important to them.

I will be off all panels officially by Aug. 1. I have started informing my current clients individually at the end of our sessions and will send out an official letter to all past and present clients within the next week. I will collect the fees at the time of service, and we will file for those who have out-of-network benefits. I will consider sliding-scale fees for those for whom this may present a hardship, and I have offered to refer individuals to other clinicians in our group who continue to take insurance. I hope many of my clients stay with me, but I will do my best for those who choose to terminate. 

Signing a contract with a managed-care company means agreeing to work for that company. What would happen to your productivity and profit if one of your employees called to ask a question and you kept them waiting for 30 minutes and then refused to answer more than one question? Or if your employees had to file their time card (like we often have to file our HCFA forms) over and over before you agreed to pay them? How long would your employees agree to work for you if you paid them much less than others in your area earn to do the same job? 

The reality is that by not being part of managed care, I can earn the same amount seeing half the number of clients. 

Onward to Aug. 1!

American Mental Health Counselors Association

675 North Washington Street, Suite 470 Alexandria, VA 22314
Phone: 800-326-2642 or 703-548-6002 Fax: 703-548-4775

 

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