NYC Therapist News (from 1994): Psychotherapy, Insurance and the New York Times

NYC Therapist News : Managed Care Changing Practice of Psychotherapy since 1994?

Managed-care companies have several names for what's ailing people who spend years in psychotherapy that the companies consider unproductive: They call it the New Yorker syndrome or the Woody Allen syndrome. And they intend to eradicate it.

But who determines whether psychiatric treatment is productive or merely high-cost self-improvement? This question has led to pitched battles between the companies and psychotherapists, particularly in the New York region, where more than 20 percent of the nation's therapists work. The battle is seen as a testing ground for the efforts of managed-care companies to scrutinize more closely medical spending in New York, where managed care has been slow to take hold.

Many therapists say managed-care companies, intent on cutting costs, are undermining the quality of care by calling the shots on treatment without ever seeing a patient. These companies, they say, favor doctors who charge the lowest fees, driving some practitioners from the profession.

"This industry is destroying the field," said Dr. Karen Shore, a psychologist and co-chairwoman of the Coalition of Mental Health Professionals and Consumers, a Long Island-based national group that opposes managed care for mental health. "Nobody wants their kid to be a psychologist anymore."

Managed-care companies and their advocates, who include some psychiatrists, counter that therapists are chiefly unhappy about the loss of income. Insurance plans have never been very generous with mental health care, but managed care is even more parsimonious.

In the New York area, typical therapy fees range from $150 to $300 an hour for a psychiatrist and from $40 to $150 an hour for a social worker; managed-care companies generally pay only 55 to 60 percent of that. One doctor said he was getting $80 a visit from managed-care companies but usually charged twice that; another was asked to settle for $40.

Supporters of managed care say many practitioners would rather keep people in talk therapy for years than try drug therapy that has increasingly proven effective. For years, these doctors had authority to continue treatment that shows no signs of working, the companies say. (Read article)


In New York we get calls all the time about accepting insurance for psychotherapy.  We do not.  And the above article is a clue as to why.  Now, if you read NYC Therapist Talks at all, then you've seen our articles elsewhere about providing evidence-based psychotherapy.  We have no sympathy for psychiatrists, psychoanalysts, social workers, or other psychotherapy providers who offer ineffective (not to mention archaic) forms of psychotherapy that takes several times a week for several years on end to provide.  Cognitive behavioral psychotherapy has been shown to be as effective as medication when used with issues such as depression and anxiety, and is not a type of psychotherapy that lasts for years.


Another thing we found interesting from this article (from almost 20 years ago) is the therapist rates for psychotherapy, as well as the amount reimbursed by insurance companies to the psychotherapy provider.  In 1994, this article is saying fees for masters-level psychotherapy providers (in that time it was only social workers) charged between $40 and $150 per session, yet were only reimbursed 55 to 60 percent of their rate.  At my office, in New York, in 2012,  we offer a sliding scale for psychotherapy based on financial need, ranging from $40 to $150.  In other words, we are charging now what therapists in New York charged in 1994 for the same service, and we are providing evidence-based (and results-0riented) psychotherapy, not long term (with questionable validity), old-school psychoanalysis. And if we took insurance, we would STILL only be reimbursed from 55 to 60 percent of that.  (Never mind that we have student loans to pay for our graduate studies, and the overhead of running a psychotherapy practice in New York just like any other business. )  Your mechanic does not take insurance.  Your plumber doesn't work on a sliding scale.  You don't have to sell your mental health to the lowest bidder just because it will save you a few bucks in the short term.  You are worth getting your life back on track, and back in your own hands and out of the hands of insurance and drug companies.

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