Term
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Definition
| Managed care is an umbrella term for the structures and programs which have been instated to combat rising healthcare costs. Included in this are government (Medicare/Medicaid) and private insurance companies which provide reimbursement for healthcare services. |
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Term
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Definition
| decreases the need for advertising;increased client-flow |
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Term
| Limits to Confidentiality w/ managed care |
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Definition
| receive reimbursement for services, providers are required to participate in a utilization review. Part of this is process involves the psychologist providing the MCO with detailed information about the client and treatment process (address in informed consent) |
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Term
| Treatment Plan w/ managed care |
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Definition
| psychologist discuss the treatment expectations of the MCO. The client should know in advance what services they will be offered, which will be covered, what limitations exist. This will allow the client to make the most educated, informed decisions about his care. |
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Term
| competence in treatment model w/ MC |
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Definition
| often MCOs require that psychologists offer services which are brief, symptom-specific, and empirically based. |
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Term
| Restrictions to therapy with MC |
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Definition
| Strain on therapeutic relationship; Session limits; pressure for quick diagnosis; treatment delays (approval); assessment |
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Term
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Definition
| condensing or restricting of therapy into brief or group models to limit costs and increase efficiency without client's knowledge that they are receiving treatment below clinical standards |
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Term
| Ethical Decision-Making and MC |
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Definition
| It is also crucial to remember that MCOs cannot prohibit the psychologist from providing services; they merely can deny payment for the services provided. Psychologists need to remember their ethical responsibilities and study the relevant ethical codes for each area impacted by participating with an MCO |
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