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A new report from APA's Office of Economic Affairs and Practice Management shows that the concerns of APA members who call the Managed Care Help Line have changed only slightly since 1996.
"Managed Care Help Line Report" examines the volume, content, and origin of calls for each year from 1996 to 1998. It is the first report to analyze data collected by both the Office of Psychiatric Services (OPS) and the Office of Economic Affairs and Practice Management (OEA).
The report shows that since 1996 the volume of calls to the Help Line has remained stable, with 253 calls a month in 1996, 254 in 1997, and 267 in 1998. The majority of calls are for information, while only 13 percent of calls are complaints about managed care organizations (MCO's). The proportion of complaint calls has decreased since 1996 (16 percent in 1996, 12 percent in 1997, and 11 percent in 1998).
Administrative hassles, denials of insurance coverage, and reimbursement problems are the most often cited reasons for making complaints. Since 1996 complaints about administrative hassles have declined, complaints about denial issues have stayed the same, and reimbursement problems have risen. While staff members working on the help line have not noticed any strong trends of late, Sandra Haas, editor of Psychiatric Practice and Managed Care, said that she has seen a slight increase in calls about confidentiality that first appear to be administrative complaints.
"Complaints may be about progress notes, but what people are really concerned about is confidentiality," she said.
Denials for insurance coverage, especially for continued inpatient services, and restrictions on prescribing medications are concerns now. Another concern is voiced by psychiatrists who are not board certified: they are encountering difficulty in getting on managed care panels.
Becky Kilmer, coordinator of the Help Line, said, "Members are looking for practical information they can use to advance their case before hospital boards, agencies, state legislatures, and managed care organizations."
For example, she said, one psychiatrist called because he needed supporting documents on treating depression under managed care. He was speaking to his agency's board of directors on behalf of patients to retain the current number of approved visits.
The Help Line was opened by the OEA in 1990 as the Managed Care Hot Line, to take and sometimes handle complaints about MCO practices. In June 1995 the service was expanded and renamed the Managed Care Help Line. OPS provided information about MCO's on the line and through the newsletter, Psychiatric Practice and Managed Care, and it "triaged" calls. OEA staff continued to handle complaints and to answer coding, Medicare, and other questions. In November 1997 all Managed Care Help Line functions were consolidated in OEA.
More information about the report is available by calling the APA Managed Care Help Line at (800) 343-4671 or writing to the Office of Economic Affairs and Practice Management, APA, 1000 Wilson Boulevard, Arlington, Va. 22209-3901.