Comparison of Private Pay Contracts to Managed Care Contracts in the Purchase of Mental Health Services


Private Pay


Managed Care (MC)
Confidentiality* Access to your record is limited to you and your therapist. MC companies often require both a diagnosis and a copy of your entire file to determine the "medical necessity" of you receiving mental health services.
Choice

You have the right to see the therapist of your choice.

 You are assigned a therapist or given a short list of providers off of which to choose.
Quality You can interview and choose your therapist based on credentials, experience, personal recommendations or any other criteria you wish to use to determine quality. You must see a provider on the MC list.  You have limited ways to determine quality of service.
Flexibility There are no restrictions on what services you design in partnership with your therapist.  The plan of and the payment of services are discussed and set by mutual agreement. The plan of care is usually strongly influenced by the criteria of what the MC company considers to be coverable activities.
Medications Medication is used only when deemed totally necessary. Medications are often considered early in treatment for the purpose of shortening the length of treatment.


Howard Lambert, Ph.D. 11/98

* If you use your health insurance to pay for counseling, be aware your insurance company and, in some cases, your employer will have access to information about your mental health.  For you to receive insurance benefits, your therapist will be required to disclose private information (a DSM-IV diagnosis and your treatment) to your insurance company. 

To protect the confidentiality of our clients, Advance Counseling does NOT participate in that process.  The clients we see choose to pay for therapy themselves so that their mental health treatment will not become a matter of semi-public record.