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	Gather and evaluate information about clinicians' experiences, attitudes and relationships with managed care organizations,
	Compare clinicians' reports of encounters with specific managed care companies
	Determine the overall impact of managed care on the psychotherapists polled.

1) Confidentiality

	In over 60% of cases, respondents indicated concern about confidentiality.
	In half of these cases, clients also expressed confidentiality concerns.
	Therapists had clients decline or quit therapy in 24% of cases due to the added risk to privacy
	In 33% of cases, therapists suspected that important information was withheld by clients fearing that it would leak to employers or others and thus make the client more vulnerable.
	In more than 75% of cases, respondents had been challenged about presenting information on treatment reports that could increase the likelihood of securing coverage.
	In 40% of cases, clients requested that therapists exaggerate symptoms so authorization for further treatment could be received.

2) Review Process

Therapists reported confusion regarding their prerogative to continue working with a client upon completion of the authorized sessions, as well as whether therapists can set their own fee with clients or must charge the same fee set by managed care companies. Of therapists working for the same managed care company, some reported that they can while others reported that they cannot continue to work with a client after completion of the authorized sessions. Respondents further reported:

In 32% of cases, reviewers were inadequate due to not being clinicians themselves, being unfamiliar with medications, being policy-driven versus case-sensitive.

	In 31% of instances, treatment was denied or cut short because it was deemed "medically unnecessary" by managed care companies.
	72% of responses indicated that the criteria for "medical necessity" has not been clearly defined by companies.
	In 20% of cases, the criteria for "medical necessity" was not publicly available.
	In 33% of cases, treatment was interrupted due to managed care companies' refusal to authorize more sessions. Of that 33%, in one third of the cases the therapist believed the clients' progress was damaged or undermined.
	In 33% of cases, the therapist felt ethically obliged to continue treatment at low or no cost.
	No therapist, fortunately, reported having been threatened with a suit for abandonment of a managed care client.

3) Reimbursement

	In nearly half of the cases, therapists reported no problems with reimbursement.
	In 16% of cases, therapists experienced denial of payment for sessions which occurred after authorization had expired or while waiting for reauthorization.
	In 38% of cases, therapists reported delay in payment due to a communication breakdown with the managed care companies.

Set 1: Summary of 39 managed care companies represented by 3 or fewer therapists:

	Companies for which providers expressed significant concern about confidentiality included Champus, Concern, Greenspring, Hillcrest, Medco, Merit, MBC, NRC, Perschoice and PSI.
	Companies which prohibited the client from seeing the therapist privately after completion of covered sessions were MBC, Merit and Perschoice.
	Companies requiring a treatment plan after 1 or 2 visits were Aetna. Claremont, Concern, Hillcrest, Interplan, Medco, Merit, MHN, Perschoice, PSI and Tricare.
	17 of the 39 managed care company providers reported experiences with reviewers who were deemed inadequate.
	78% of respondents stated that the criteria for Òmedical necessityÓ had not been clearly defined by Blue Cross, CCN, Concern, Champus, Helpnet, Hillcrest, Interplan, Lifelink, MBC, Medco, NRC and PSI.
	12 of the 39 companies were reported to extend authorization for sessions.
	12 companies were reported to have damaged or undermined clientsÕ progress because of refusal to authorize additional sessions. These companies were Aetna, Concern, Champus, FONH, Greenspring, Hillcrest, Interplan, MBC, Medco, Pacificare, PSI and Vista.
	Therapists representing 11 companies reported having felt ethically bound to provide no or low cost care when coverage was denied.
	16 companies delayed payment due to communication breakdown.
	4 companies, Champus, Hillcrest, Medco and Merit, denied payment for visits which occurred after authorization had expired or while waiting for authorization.

Set 2: Comparison of 4 managed care companies represented by 4 or more respondents. Similarities and differences are highlighted among Blue Shield (11 providers responded), U.S. Behavioral Health (USBH - 7 providers responded), Occupational Health Services (OHS - 5 providers responded) and Value Behavioral Health (VBH - 4 providers responded):

a) Confidentiality

	Confidentiality concerns for clinicians and clients: Blue Shield (4 of 11), USBH (5 of 7), OHS ( 4 of 5), and VBH (4 of 4).
	Clinicians' experience with clients declining or leaving therapy because of concerns about confidentiality: Blue Cross (0 of 11), USBH (3 of 7), OHS (4 of 5), VBH (2 of 4).

b) Review Process

	Complaints about inappropriateness or inadequacy of reviews were infrequent from providers for all four companies. However, in at least one instance for each company, a provider reported encountering one reviewer who was thought to be inappropriate and one reviewer who was deemed inadequate.
	Treatment cut short because care was deemed "medically unnecessary", almost half of the providers responding from USBH, OHS and VBH reported experiencing this, while only 1 of 11 providers for Blue Shield experienced this.
	The criteria for "medical necessity" not clearly defined: Blue Shield (6 of 6) who responded, USBH (5 of 6), OHS (4 of 5) and VBH (2 of 3).
	The criteria for "medical necessity" being publicly available: Blue Shield (5 of 5), USBH (3 of 5), OHS (4 of 4), and VBH (2 of 3).
	50% of providers for USBH and OHS reported therapy being interrupted when client's managed care company refused to authorize additional sessions, while only one provider from Blue Shield and one from VBH had had this experience.
	Providers from all four companies felt ethically obliged to continue care at no or low cost when further coverage was denied by managed care companies.

c) Reimbursement

	Denial of payment for visits which occurred after authorization had expired or while waiting for reauthorization: USBH (3 of 7 respondents), Blue Shield (1 of 5), OHS (1 of 4), VBH (1 of 3).
	Delay in payment due to communication breakdown: Blue Shield (3 of 6), USBH (4 of 7), VBH (2 of 3), OHS (1 of 4).