I choose not to work with managed care for the following reasons.

The man who founded HMO's dies suddenly and finds himself at the Gates of Heaven with St. Peter.  I can't believe I am going to be admitted to Heaven, says the man overcome with joy and gratitude.  Saint Peter looks at him and says, Of course you are going to be admitted to Heaven............Dramatic Pause...FOR  3 DAYS. 


There is a lack of confidentiality with the insurance companies who require a mental health diagnosis. This diagnosis is required to be disclosed to companies requiring security background checks. In an era where companies research credit ratings, this can be an impediment in getting hired. In addition, I am concerned that with the history of computer hacking, that putting this information in a large database makes the information on databases a target for hackers, regardless of the safeguards put on them, hackers will be working to find ways around them. In addition, Relationship therapy is not covered by insurance. This means that the only way to bill is to make one partner the patient and the other a family member invited into family therapy. These sessions are limited in the quantity allowed and the time allowed for each session.

Insurance companies decide how long a session can be and be compensated for. I only do 90 minute sessions for Intakes and Couples or Families. A 90 minute intake allows the process of working on the issues of concern more quickly, allowing time to collect information and begin working with clients to begin to resolve them in the first session. Insurance companies will only pay for a 45 minute session, except in rare circumstances.

The same difficulties pertain to Couples and Family sessions, which are much more effective when done in 90 minute sessions. The typical 45 minute session proceeds where, 20 minutes are spent getting the clients to decide what they most want to work on, for both people to have a chance to speak, and there is not enough time to teach skills and have the couple use them in the session, to achieve real progress.

Difficulty getting authorization without mental health diagnosis

Insurance companies can tell the provider what they can do, i.e. including how many sessions they will pay for. How long client sessions can be as well as how often. The insurance company can override Decisions by the Therapist and the client.