H Berryman Edwards, MD, FAPA

ASK DR. DENIAL

October, 1995

Peter Knoepfler, MD from Bellevue, Washington writes (via e-mail: Good for you, Peter!):

Dear Dr. Denial:

Is the managed care company [MCO] responsible if patients leave treatment because of unreasonable demands for private information?

Dear Peter:

Responsible for what, Peter? For the patient leaving treatment or for what happens to the patient as a result of leaving treatment prematurely? (These days it seems like whenever something bad happens, the responsible party is always somebody ELSE! unless you're a doctor, then it's always your fault!)

Actually as a (very small time) stock holder in one of the largest behavioral MCO's I see the ideal this way: The demands on the potential patient are so offensive that NOBODY SEEKS TREATMENT! All that insurance money goes right in my pocket! Ditto for the capitated group. Just like buying a lot of land and having the government pay you not to grow crops. Now you get paid not to treat patients! What a deal! The obvious alternative is for the patient not to access his insurance benefits, something that has been done for years to avoid even allowing the company know the patient is in treatment.

Ah, but this is the real world, and there are those desperate enough to spoil it for the rest of us by actually accepting treatment. We'll have to work for a living. I think the more interesting question is: Who is responsible for informing the patient of the "unreasonable demands for private information?" Ordinarily I would say the insurance plan, the MCO, or the employer. But did you sign one of those six page provider contracts? If you sold out to the big guys, it's a whole new ball game! Then I'd make a strong case that YOU are responsible! And you might not even know what to tell your patient! (How much do MCO's tell you about what happens to all that information?) And I'll bet the contract stipulates you agree not to treat the patient outside of the plan, i.e. not accessing that insurance money. Again, good news for the stock holder!

Actually, in Dr. Denial's experience as a reviewer, providers are often far too willing to provide unnecessary personal information! Put yourself in my shoes. How can any psychiatrist render a useful opinion about any case without reasonable access to historical information?