United Tehama Employees
SEIU Local 1292
407 Walnut Street, Upstairs
Red Bluff, CA 96080                                                                              April 20, 1998
(530) 528-2960

Dear Sirs/Mmes:

May I please add something to your thinking about the type and brand of health insurance Tehama County adopts. My ideas are, of course, biased in my favor since I wish to provide again psychotherapy and counseling services to Tehama County employees, who used to be perhaps the most numerous group among my many and diverse patients.

As of now, I do not provide services to County employees because being mad, upset, and fed up with managed care, I have withdrawn from the pool of providers approved by Foundation Health, or Managed Health Network, or Heath Net — whoever it is at the current time that provides or oversees the covered counseling and psychology services of County employees.

"Whoever it is!" I’m not kidding. The names and companies have changed so many times over the past two years that the only certain thing is they’ll keep reducing my fees (now at 60-65% of my normal fee), keep increasing my paperwork load with unnecessary and insignificant requests, and try to keep you from utilizing my services by erecting bureaucratic roadblocks.

For example, they’ll never approve more than 5 sessions at one time, meaning I have to refile paperwork almost monthly, a task that they justify as "medically necessary," but in reality makes you and me so tired of the system we tend to say, "forget it," while they gleefully report "reduced utilization gives stockholders more savings." And you know when you try to call them about something? It usually takes a whole lot of time, and don’t we all get upset (maybe I even more than you) with the voice-mail run-arounds that can cut you off to a dial tone.

Foundation Health once sent me back a claim because I had not added the numbers "01" to the end of the patient’s social security number! They could have easily done it themselves, for they had the patient’s name and birth date and knew who the insured person was. So, I can only take it that they were hassling me and giving themselves an extra couple of weeks of "float" on the money owed me, which, although a small amount, can really add up over many, many doctors.

Another time, a managed-care company (also Foundation, if memory serves me) approved an emergency session for a suicidal patient. The doctor in Redding called me on Saturday, and I saw the patient, as a special favor, on Sunday. The doctor’s office prepared the paperwork request on the following Tuesday, and because I put the dates down honestly, the company refused to pay since I saw the patient "before it was authorized"! I finally did get paid — only after I spent so much time on the phone, and writing appeal letters, that I literally would have been paid better flipping burgers.

(The number of mistakes and hassles from managed-care companies like Foundation Health, Managed Health Network, or Health Net is at least 10-20 times as much as, say, Blue Cross, who is much more likely to let the provider do his/her job without bureaucratic interference.)

The managed-health people passing judgment on whether or not, and how much, I can treat you are typically close to entry-level professionals, with probably 25 years less experience than I, who may have had trouble making it out in their own practices and had to settle for a lesser-paying job. They look your problems up in a "cookbook" prepared by cost-cutters and judge the severity of your problems by how well the doctor (me) can say the proper words. They are always aware that if they don’t keep costs down (i.e., your use of services), they can get fired.

The managed care companies sell their "product" (that’s what they call health care) by offering cheap prices. And that surely looks good to a lot of people, until they get sick or need professional care. Then, when they read the fine print, they often find that they got just what they paid for: cheap care. More and more of the top-notch, experienced professionals are dropping out of managed care, which means you might have to drive further to find lesser-experienced, more financially-needy professionals who are willing to put up with a stifling bureaucracy that doesn’t pay well at all — if and when it gets around to paying correctly.

Therefore, when it comes time to approve a health care plan that includes mental health benefits, I think you’re much better off going with a PPO plan, or at least a plan that has options other than those offered by Foundation Health, Managed Health Network, Health Net, or other such managed-care plans. It’s like bad tires: you pay less and get less safety and mileage — so it’s more expensive in the long run. Only Blue Cross’s HMOs seem the rare exception to this.

And, to avoid the fiasco that happened when the County switched from Blue Cross California Care to Foundation Health, any new company should guarantee in writing that they will cover any extraordinary expenses incurred as a results of switching plans. (Remember what happened at the last switch? Not many doctors in Red Bluff were certified, so for several months people had to drive to Redding or Chico and sometimes just pay out of their own pockets. And, trying to get reimbursed for those visits usually ended up with a petty clerk telling you that, "Sorry, it wasn’t authorized, so we won’t pay for it.")

May I respectfully request that before the County approve a new plan, representatives of the union local call Tehama County doctors, psychologists, therapists, etc., to get feedback from those professionals about the type of plan it is and the reputation of the company?

Finally, feel free to ask me any questions, any time. My office phone rings in my home, and my home phone is listed.

Treating the people of Tehama County for the last 7 years, and people in general for the last 30+ years. Formerly, Dean for Faculty, California School of Professional Psychology, San Francisco; Asst. Chief, Psychology Service, Letterman General Hospital (U.S. Army), San Francisco; Staff Member, Family Therapy Institute of Marin; Fellow, Academy of Clinical Psychology, American Board of Professional Psychology.