Providing Therapy When Managed Care Organizations Deny Reimbursement

Abstract

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.

Key Words:

• Managed care
• behavioral health
• private practice
• psychotherapy
• reimbursement
• social work services