Shrink Rap

Middlemen Eviscerate Mental Health Benefits

Even as the market affects what happens to patients, it is unclear whether the behavioral health companies are subject to patient-protection laws. Gayle O'Brien, the director of legal and regulatory affairs at the New York State Psychological Association, says that several of the organization's members have complained that they were recently taken out of the provider network of Merit Behavioral Care (which has since been taken over by Magellan) without any notice. "New York State has a law that prohibits that kind of termination," says O'Brien, "but the law speaks in terms of health care plans, HMOs, and insurers, and Merit doesn't fall into any of those categories."

In what Shore might call a minor resistance movement, some psychologists are suing managed behavioral health companies, along with managed-care companies, alleging that both are violating their contracts and misrepresenting their policies. The suits, which are coordinated by the American Psychological Association, will make the argument that taking treatment decisions out of clinicians' hands is dangerous for patients.

But proving such a case is near impossible. When it comes to mental health, outcomes are less clear-cut than in other areas of medicine. So, while therapists point to studies that show patients benefit when they and their providers control treatment, the industry refers to other literature that suggests patients are better served by its shorter-term approach. And regardless of whether they're right, the new managed behavioral health companies are running the show their way—which also happens to be the cheapest way.

« Previous Page