Here, I want to use simple words and share the situation that has prompted this resolution. Over the past few years, it has become readily apparent that certain children in my pediatric practice have difficulty obtaining required mental health services. If I see a child with an acute abdomen which needs a surgeon's skill, I can refer the child for surgical evaluation and can participate in the care until the problem is resolved. In the current era of health care reform, some of our insurance plans have taken away our referral privileges when the diagnosis is in the behavioral or emotional categories. The parent or parents of the child in need, is required to find a mental health provider for themselves with the insurance plan's contracted agency.
Reality is that the insurance protocol provides confusion and anguish.
This brave new cost control system provides no communication between the primary physician and the provider of the mental health service, nor does the primary care physician receive any report of the diagnosis, medications or therapy given. I am the last to know who is seeing the child, my patient, what happened or what therapy is proposed or given. Physicians, as their advocates need to shine some light on this situation and to ask others to compare their notes and support the call to resolve this problem. Since we can't communicate, I have no way of seeing or determining the efficacy or outcome of such strategies.