the Best Choice for Your Mental Health Plan
changes have occurred in the health insurance industry
that may affect your access to quality mental health care.
More employers are contracting with "managed care"
plans to monitor delivery of mental health care.
care companies act as gatekeepers between you and your
insurance benefits, in an effort to contain costs and
increase profits. Managed care companies limit benefits
and dictate treatment terms. This may directly affect
the quality of care you receive.
changes can be confusing to you, the consumer, as you
try to understand which insurance plan will best meet
your needs. This page is designed to provide information
to consider when investigating your options.
may have questions to discuss with your benefits manager,
your insurance company's representative or your psychotherapist.
you are uncomfortable with an insurer's policies regarding
choice of therapist, length or type of care, or confidentiality,
you may want to know what other options you have.
Do Have A Choice.
You Make The Choice:
You have freedom
of choice in selecting a psychotherapist who best fits
You and your therapist
agree on the fee.
You decide with your
therapist the length of your treatment.
You and your therapist
decide what type of treatment will best meet your needs.
Your right to
privacy is safeguarded. Confidentiality is protected within
the limits of state law.
Your Managed Care Plan Makes The Choice:
choice of psychotherapist may be limited to a short list
of persons who have a contract with the company.
managed care insurance plan sets the fee.
plan decides if treatment is covered, and if so, how many sessions
it will pay for, based on a reviewer's judgment of need.
of treatment will be dictated by the plan. You may be
limited to brief therapy or crisis intervention. Use of
medication may be required or offered as the only treatment.
are required. Records are the property of the managed
care company. Managed care employees will have access
to clinical information that would otherwise remain between
client and therapist.
Can You Do?
selecting an insurance plan, find out what mental health
benefits are provided with each option available to you.
Get your questions answered before you sign up.
with your psychotherapist exactly what information your
insurer requires. Assess any possible impact if this information
becomes accessible to others. If paying for therapy privately
is too difficult for you, discuss with your therapist
the possibility of flexible fees or payment schedule.
to the human resources department of your workplace. Tell
them your concerns and preferences.
or call your state and national legislators about your
concerns and opinions.
more than feeling low or blue from time to time. It is
an illness, and it can affect anyone. It does affect between
5 and 25 % of the population sometime during their life.
Symptoms of depression include:
sad, empty, hopeless, or helpless
An inability to enjoy pleasant experiences
Major or sudden weight loss or gain
Fatigue or loss energy
Low self esteem
A sense of being in slow motion or speeded up
Thoughts of death or suicide
are different kinds of depression. Major Depression is
a severe depression lasting at least two weeks. Dysthymia
is a less severe but usually more long-lasting depression.
Seasonal Affective Disorder is depression which is affected
by the amount of sunlight a person is exposed to. Bipolar
Disorder is depression mixed with periods of mania, where
the individual needs little sleep and often acts impulsively.
be caused by many factors, including significant life
stress, loss, family history, and biology. Sometimes the
reason for a person's depression is never determined.
The severity, duration, and frequency of depressive episodes
are widely variable. Some people have only one episode
of depression, while others experience depression on and
off throughout their lives.
might also be a main symptom when other major family problems
exist, such as alcohol abuse. It is a problem that reaches
beyond the particular individual who is depressed. Families,
friends, and co-workers of a depressed person are often
impacted, as relationships become strained.
IS DEPRESSION TREATED?
two main ways of treating depression are through medications
and psychotherapy. Either or both of these methods can
be utilized, depending on the type of depression being
must be prescribed by a doctor or certain types of other
medical professionals working under a doctor's guidance.
Psychiatrists are doctors who specialize in psychological
disorders, and are most familiar with medications to treat
can be provided by several different types of professionals,
all of whom must secure a professional license to practice
therapy in California.
are many different methods of providing therapy. A person
seeking therapy for depression has the right to ask questions
of the therapist they are thinking of working with. It
might be important to know what the therapist's experience
in working with depression is, as well as how they work
toward alleviating depression.
IS TREATMENT PAID FOR?
people pay for treatment themselves, without any contribution
from a health insurance plan. Others utilize health insurance.
Some health insurance plans cover the cost of medications
or therapy in whole or in part. Many ask for a co-payment
from the insured person. Some will cover only certain
health care providers, only a certain number of sessions,
or have other stipulations. Individuals who have health
insurance can benefit by determining what their insurance
covers, and what insurance options are available to them
if they find their current insurance unsatisfactory.
Good for your Health
When the alarm
rang at 6:00 am, Susan Smith could not possibly get out
of bed. She was still exhausted, having slept poorly. Her
stomach felt upset and she just didn't feel right. She called
in sick, something she had been doing a lot recently. When
she saw her doctor later that day, he again found nothing
wrong with her physical health. Noting that she had seen
him four times in the last three months with the same complaints
of difficulty sleeping, poor appetite, tense stomach and
lower back pain, he modified her sleeping medication and
inquired about her stress level. "My boss is giving
me a bad time. She says I've been missing too much work
and my productivity is way down. Maybe I need a vacation."
is a fictitious person, but people in situations like hers
are everywhere. Maybe she is depressed, anxious, or abusing
a substance. She repeatedly visits her doctor when she may
likely need to see a mental health professional. Meanwhile,
she is using health insurance dollars to no avail and losing
her company money.
focus on their medical needs when shopping for health insurance,
and it is an appropriate focus. The vast majority of health
care dollars go towards the nation's physical, rather than
psychological, health. However, as the above vignette and
the following statistics indicate, an individual's psychological
health is interwoven with their physical health. Broadening
the focus to include both physical and psychological health
in health care packages results in insurance that is a more
comprehensive and accurate reflection of people's needs.
illness is the third most limiting health condition, in
terms of being able to perform major daily activities, exceeded
only by cancer and stroke. Regarding inability to work,
mental illness is the most limiting health condition. (Mental
Health Policy Resource Center, Database, 1990)
impact of mental illness and substance abuse on workplace
productivity is well documented. These disorders can impair
an employee's ability to function productively, increase
the chance of employee injury, and increase employee absenteeism.
(American Psychological Association, Practice Directorate,
of all physician visits are by people with no physical problem.
This figure rises to 90% when stress-related illnesses are
also included. (Gail Schapes, Ph.D., The California Psychologist,
to 90% of all industrial accidents are likely related to
personal problems and employees' inability to handle stress.
(Neil Thakur, James M. Jacobson, J.D., American Psychological
Association Practice Directorate. June. 1992)
to the insurer Northwestern National Life, the average cost
per person in lifetime disability payments for stress related
illness is $73,270. However, the average cost to rehabilitate
a stress-disabled employee is only $1925 -- a savings of
over $71,000 per employee. (Walker, C.K., 1991, Stressed
to Kill. Business and Health, Sept. p. 42)
Six of the top
ten health problems chosen by over 400 corporate leaders
as most seriously affecting their companies' work force
can be treated by mental health professionals. The problems,
along with their ranking, were: Cigarette Smoking (#2),
Alcohol Abuse (#4), General Mental Health Problems (#5),
Stress (#6), Drug Abuse (#9), and Depression
(# 10). (Yanson, J., 1991, The National Executive Poll on
Health Care Costs and Benefits. Business and Health, Sept.
doctor referred her to a mental health professional. If
she was diagnosed and treated for depression, she would
have a 77% chance of a better outcome than depressed patients
who did not receive treatment. (Robinson, L.A., Berman,
J.S., and Neimeyer, R.A., 1990. Psychotherapy for the treatment
of depression: A comprehensive review of controlled outcomes-research.
Psychological Bulletin. 108, 30-49.)
she was diagnosed and treated for panic disorder, she would
have a 70-90% chance obtaining "significant relief"
through psychotherapy. (Office of Scientific Information,
1992, Panic Disorder Fact Sheet, National Institute of Mental
If she was diagnosed
and treated for alcohol abuse, "brief motivational
counseling, self control training, social skills training,
behavioral therapy are among the types of treatment found
both most inexpensive and most effective in eliminating
or reducing the effects of alcohol abuse". (Holder,
H., Longabaugh, R., Miller, W.R. and Rubonis, A.V., 1991,
The cost effectiveness of treatment for alcoholism: A first
approximation. Journal of Studies on Alcohol, 52 (6) 517-540)
Referrals to community resources, such as AA, are also part
of alcohol abuse treatment.
Smith, and thousands like her, suffer from mental disorders
that are treatable through psychotherapy. Gone untreated,
they cost employers in lost productivity and cost insurance
companies in over-utilization of medical benefits. Mental
health is a large part of overall health. Choose an insurance
package that includes adequate and easily accessible mental
health coverage. After all,
psychotherapy is good for your health.