159. What are some of the advantages and disadvantages of using managed care?

Advantages:

• Sometimes there is no deductible.
• Your co-pay may be less than POS coverage.
• A provider is chosen for you.

Disadvantages:

• Pre-approval is required before starting treatment.
• You must tell an insurance company representative about your problem to be approved, no matter how embarrassed you are to talk about it.
• You are limited to panel or network providers, and sometimes have no choice at all. Often there are many more therapists with less training and experience.
• Network providers may not be conveniently located.
• Network providers may not have appointment times available that fit your schedule.
• You may have to wait weeks for an appointment.
• Network providers may not have expertise in treating your problem.
• Network providers may have less education and experience than other local professionals.
• There is limited confidentiality. The managed care company receives treatment summaries with details of your problem and treatment.
• Treatment is usually more time-limited than in POS coverage.
• You must receive authorization for all treatment.
• The provider may be reluctant to ask for more treatment sessions because it is a "hassle."
• Non-authorized or non-approved treatment will not be covered.
• Type of treatment and length of treatment must be approved by managed care.
• If you appeal managed care limits, coverage (and treatment) must wait for the appeal.