The whole process can eat up months of waiting time. People give up, go away, and suffer. The company makes money. There needs to be an entity independent of the managed care company to which patients can turn for a review that has some integrity, and it needs to be accessible with minimum delays. Reviewers in all settings should be licensed mental health professionals whose licensure binds them to responsible clinical decision-making as reviewers just as such licensure does for practitioners.
Plans differ in their philosophy about what is necessary.
They may define it broadly in terms of a deficit in the quality of life that has the potential for improvement through treatment. More often plans consider necessity in narrower terms, to mean an imminent risk of death or disability that can be corrected or avoided by very brief treatment. Under those terms, subjective emotional pain or nonlethal self-destructiveness may seem minor or even spurious. Even suicidal intention has sometimes not been deemed an emergency until the patient carries out an attempt. Instead of being honest and saying how much service the plan really covers, or that it only covers stabilization during crises or only medication, managed care companies say they offer the full range of mental health services, including much more care than they usually authorize.