Q:I am contacting LCL because I have become exasperated attempting to find either a therapist or psychiatrist for help with my increasingly severe anxiety. The frustrating self-referral process, itself, has made the anxiety worse. My managed care health insurance company gives me names, but when I call the clinicians I find no one who actually has time to see me.
A:Unfortunately, access to mental health care has continued to worsen (for people using health insurance) since the advent of managed care. At first, the managed care companies (in most cases, "carve-out" companies that handle only mental health and substance abuse treatment) kept their provider lists too small, refusing to sign up providers who wanted to join the "panel," and some also made it difficult to get more than a couple of provider names at a time. While provider panels in certain areas (like Boston/Brookline/Newton) are often still closed, that problem has decreased, and nowadays most companies offer on-line provider lists. The newer source of frustration is that so many clinicians have opted out of the managed care morass that there seem to be too few with open slots in their schedules.
If you are in a position to pay for your treatment out of pocket, or if you are one of the few who has "indemnity" health insurance (will pay any licensed provider, even one who does not have a contract with a managed care organization), the process of finding treatment is much easier. There are other benefits, as well, to not using your managed care plan, including: (1) Your therapy will not be abruptly cut off when the managed care folks think your treatment is not "medically necessary"; (2) You have truer confidentiality, as the provider is not compelled to provide clinical information to the payer; (3) You can select providers based solely on recommendations and expertise rather than on whether they are on a particular list.
However, many people cannot afford to self-pay. (Fifty-minute sessions generally range from $90 to $130 or more, depending on factors including the type of clinician.) At LCL, we are accustomed to spending a good deal of time trying to match clients with treatment providers based not only on type of problem and personality "fit," but also on factors like geography and managed care company. You are much more likely to end up satisfied than by choosing random names from an HMO list. But, we must admit that it now takes significantly longer (especially considering the multiple criteria we use to try to make an excellent match) to complete the referral process.