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(p. 265) The Basics of Managed Care and Its Impact on Private Practice 

(p. 265) The Basics of Managed Care and Its Impact on Private Practice
(p. 265) The Basics of Managed Care and Its Impact on Private Practice

Gordon I. Herz

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date: 17 January 2020

This chapter describes “managed care” insurance systems and practices that were created to manage healthcare costs. Effects on private mental health practice are identified, such as decreases in reimbursement, documentation requirements, treatment reviews, and other intrusions into clinician–client privacy and decision making. Potential advantages of participation are also identified. Key factors that private practitioners should take into account when deciding whether to participate with managed care organizations include careful contract reviews, likely credentialing requirements, and the impact of reimbursement on a practice. Potential solutions to common challenges are provided, such as limits on balance billing and waiver of co-payments. Ethical concerns specific to providing mental health treatment in the managed care context are discussed, such as limits on privacy and confidentiality. Potential implications of the ongoing seismic changes in the healthcare system for the future of managed care and private practitioners are explored.

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