QUESTION: "In
the January, 2009, issue of Psychotherapy Finances you
published a list of the biggest companies in managed care. I noticed
that if you total up all the covered lives numbers, it comes to more
than two hundred million. There can’t be that many people enrolled in
managed behavioral health care plans, can there?"
ANSWER:
No there can’t. "Covered lives" is a term of art in the the insurance
business. It doesn’t necessarily mean a single individual. Most payors
count the number of members covered by a contract for a particular
service--such as managed behavioral health, or EAP, or utilization
review. Under that definition, these companies might count the same
individual several times in their covered lives figures: once for
managed care, once for EAP, and so on.
QUESTION:
"I’ve read several stories in PsyFin about therapists who do
Internet therapy to serve more clients in different states. But my
impression is that you have to be licensed in each state to do that.
Am I wrong to be nervous about this kind of work?"
ANSWER:
This is something of a gray area. Distance services (phone, email,
live Web chat, etc.) are increasingly common. In particular,
clinicians who offer coaching services like to work this way. And
perusing therapists’ Web sites, we’re seeing distance services
advertised more openly than a few years ago. But there’s a
disconnect between what’s actually happening, and what officialdom
chooses to recognize.
The professional associations take a generally negative view.
(Counselors are an exception--see the box below.) In theory, some
officials say, a clinician could be liable for ethics charges or even
loss of license if they "see" a patient who’s physically in another
state.
The lawyers and malpractice carriers we discuss this topic with
are a little skittish as well. And Glennon Karr, a health care
attorney we consult frequently on legal risk management topics, tells
us that the counseling and social work board in his home state of Ohio
is looking at a new rule saying, in effect, that the therapy is
taking place wherever the client is.
"So if the client is in New Jersey and you’re providing services
from Ohio, they could file a complaint against you with the New Jersey
licensing board."
There are no cases yet, Karr concedes. "There’s nothing really
clear on this."
Insurers aren’t happy with the concept of Internet services
either, but coverage remains in place, says Eric Marine,
vice-president of claims for the American Professional Agency, a
malpractice insurance broker based in Amityville, NY. "Covered is
covered," he says.
"We don’t define what the process is... As long as there are no
problems out there, we don’t have anything to say about it. But we’re
concerned about it as is every insurance company in America."
