Managed care companies use the information that I am required to provide in order to decide if treatment is medically necessary in the first place and, later, if it should continue. Many who make these decisions have limited training in therapy.
Managed care companies make money by reducing how much treatment occurs. Therapists worry that economic goals may color their decisions. In other words, the criteria they use may be quite different from those you and I use.
Reviewers have formulas they must follow in making decisions. Some formulas and averages cannot account for human individuality. Therapy done by formulas cannot afford the careful listening that years of scientific research have shown to be the cornerstone of effective therapy. Therapists who belong to some managed care panels are pressured to follow the same formulas or lose membership on those panels.
The two people who can make treatment decisions are the client and the therapist, in partnership. It used to work that way. Today, if you depend upon health insurance benefits, it may not.
Control over treatment is also lost because some kinds of services and problems are not covered. For example, marital counseling and biofeedback are usually not covered even though their effectiveness is well known. Therapy for long term personality problems is almost never covered by managed care.
Managed care companies usually agree to cover treatment only to the extent that it focuses on symptoms. Managed care is a system that works best in dealing with crises. However, if people do not come to terms with the underlying issues, new crises are likely.
