Volume 1, No. 12 Winter 2001 Bernadette, LCSW was pleased when ACME Healthcare accepted her application to join its provider panel. ACME had a large client base and offered a better than average mental health benefit to its clients. However, Bernadette was taken aback by the restrictive language in the contract she was offered.
Many therapists maintain a private practice and participate in some managed care arrangement also.
Sometimes therapists will join as many panels as possible without fully realizing the implications and the differences in the managed care contracts being offered. Since managed care contracts are designed to influence provider behavior, this lack of in-depth review and close scrutiny may have serious consequences for the therapist. While it may be impossible to strike a hold harmless agreement from a contract, many MCOs accept a mutual arrangement, which also indemnifies the therapist for mistakes made by the company. Referral restrictions require that a client be referred back to the MCO or another member of its panel. Try to negotiate for the right to refer to a provider outside the panel.