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Reports on the role of managed care organizations in determining whether services are medically necessary in the U.S. Likelihood of provider organizations to be reimbursed for behavioral health services to managed care patients; Requirement that clinicians note a patient's Global Assessment of Functioning score; Consideration of the endpoint of treatment to be when a patient is capable of tolerating his or her symptoms.

Behavioral health clinicians tend to believe that all services that they provide to patients should be reimbursed when publicly funded or commercial health plans are involved. The reality, however, is that many services are not covered, which can result in a significant number of hours of clinical work for which provider organizations are not reimbursed. Few provider organizations can afford that, especially in the current economic climate. Some organization leaders may actually not be aware of the full extent of non-covered services being provided by their clinicians. To minimize the adverse financial impact of providing an excessive volume of non-reimbursed services, leaders of behavioral health provider organizations need to establish a culture that actively discourages the common clinician attitude of, "If I say it should be covered, then it should be covered." Clinicians need to learn that health plans decide what services are covered and not covered, and that clinicians are responsible for minimizing the provision of non-covered services.