Psychotherapy Finances is a nationally circulated newsletter for psychologists and other mental health care providers in private practice. Below is an article I wrote for the May 2012 edition on new lawsuits by psychologists aimed at managed care. The article on marriage friendly therapy can also be found in the May issue.
To read the Psychotherapy Finances blog, updated every Friday, click here.
Latest round of managed care lawsuits focus on fees, access
Mental health professionals--and the American Psychological Association in particular--have for decades looked to the courts for relief from the predations of managed care.
And they’ve scored a few victories--most prominently in a class action suit settled in 2005. In that suit, originally brought by physicians against 12 major managed care organizations, plaintiffs successfully argued that the companies conspired to deny them compensation.
Now, lawyers from the American Psychological Association are working on other fronts. A big part of the current strategy is finding ways to construe routine managed care policies as violations of parity. “Managed care is like a moving target,” says Shirley Ann Higuchi, APA’s assistant executive director of legal and regulatory affairs. “Some issues that were problematic 15 or 20 years ago have been corrected. But then they come along with something new that’s equally problematic. We end up chasing
them down every time they switch gears.”
● One current battleground is Florida, where the APA has accused Blue Cross/Blue Shield of violating the federal parity law by enacting a 33%-54% reimbursement cut. (That’s the “New Directions” fee cut mentioned in last month’s lead story.)
The cut only applies to mental health services. That, APA argues, “violates the Interim Final Rules” on parity issued by the Department of Health and Human Services (HHS) in February, 2010. APA’s Practice Directorate (that’s the office within the Association
that focuses on private practice issues) is arguing that the Florida case di-rectly parallels a 2003 case. In that instance, CareFirst was sued successfully by the Virginia Academy of Clinical Psychology (VACP).
Access and fraud were at issue. VACP contended that 30% rate cuts led directly to wholesale panel resignations, which in turn meant that the extensive provider network CareFirst promised its members was actually a “phantom network.”
“It’s a very similar factual scenario,” says Alan Nessman, senior special counsel with the APA. “A big rate cut causes concerns about providers being driven out of the network. It’s going to have a big impact on patient access to care.”
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TRENDS: More clients are looking for 'marriage friendly' therapists
Rightly or wrongly, some clinicians have been criticized for taking a neutral approach when they worked with troubled couples. They’re not really trying to save the marriage, some say. Instead, they’re just smoothing the way for divorce.
So a new marriage friendly approach to couples counseling is gaining currency. The specific goal is to keep the marriage intact. Since this is what many or most couples want when they go looking for a therapist in the first place, this makes excellent marketing sense.
Below, we look at two California practitioners who have adopted this approach with considerable success.
● Kathy Jarosz is a San Francisco therapist who’s been providing couples counseling for 30 years. About three years ago, she switched to an explicitly marriage friendly marketing approach. Part of doing that was signing up for a $20-per-month listing on the “Marriage Friendly Therapist” directory.
“I resonated with the marriage friendly idea,” says Jarosz, who has two offices in the Bay Area--one in San Francisco and another Corte Madera. “I think it’s a better message to give clients, and I talk to people about it upfront. They want to see the right person and feel that they’ve made a good choice.”
And it works for her, she says, because more clients these days are looking for a marriage saver, not just a relationship facilitator. “Hitting the right nerve with [prospective] clients is the key,” she adds. Jarosz is actually listed on three different web directories, all of
which link back to her website, www.couplescounselingworks.com. In addition to the Marriage Friendly Therapy directory, she’s also on the directory at PsychologyToday.com ($30 a month), and the one at www.goodtherapy.org ($24.95). That last one was launched in 2007.
“A lot of people who call me have looked me up in one of the director-tories first,” she says. “Along the way, they’ve seen so many different websites that they can’t really trace exactly how they got to mine, but they’ll say something like, ‘Oh, your website is really positive and that’s why I called.’”
Jarosz has been trying to increase her private pay clients but complains about being “mired” in insurance work. Her standard fees are $160 for 50 minutes, and $240 for 75 minutes. But her third party reimbursement can be as low as $60 for 45 minutes, and they don’t approve 75-minute sessions at all.
"I’m dealing with panel nightmare issues,” she says. “I’m tired of it, but I still have to get paid. I spend all of my time when I’m not with clients on billing, and billing follow-up. I have been getting more private pay clients lately, but it varies from week to week.”