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The article reports on the reimbursement for telephone sessions conducted by managed care organizations (MCOs) and commercial health plans with patients. Providers and provider organizations believe that they should be reimbursed for telephone sessions with patients, however, this article presents the reasons why MCOs and health plans will not pay for telephonic sessions.

The article discusses the coverage of family and marital therapy by managed care organizations in the U.S. in 2006. While managed care organizations generally recognize family and marital therapy as a vital modality in the treatment of certain individuals, they need to enforce coverage rules when managing the health plans of other entities. Thus, they deny family and marital therapy as non-covered services for other patients in some cases.

The article discusses issues concerning the medical reviews required by managed care organizations (MCOs) and insurance companies and whether they can be done after rather than during treatment. If reviews are not read until after treatment, MCOs and insurance companies are not aware of the services until they receive the claim. If reviews are done retrospectively, the MCOs could audit the charts and the documentation, find discrepancies, and possibly rescind authorization.

Focuses on the criteria needed for managed care organizations (MCO) to receive approval for inpatient admissions. Tendency of MCO to scrutinize inpatient mental health treatment more intensely; Application of danger to self in very recent attempted suicide or self-harm behavior; Presence of established high-risk factors for suicide; Attempts to harm others.

Focuses on the phone etiquette during managed care review. Use of written reports by managed care organizations (MCOs); Process of telephone reviews; Effect of handling phone reviews to MCOs. INSET: A Message from the Editor.

Reports on managed care organizations (MCO) that continue to manage behavioral healthcare for Americans, including those enrolled in Medicare, Medicaid and other publicly funded health plans. Focus on current symptoms and functional impairments in written reports; Emphasis on time-limited or brief treatment; Delineation of goals of treatment.

Looks into the necessity of managed care as a factor for revenue increase plans by behavioral health providers in the U.S. Demand seen in the use of managed care by the public; Importance of managed care organizations among the providers; Key in maximizing reimbursement; Need for the providers to understand medical necessity.

Discusses issues concerning the acceptance of clinicians in insurance and managed care provider companies. Criteria for selecting clinicians in managed care companies; Treatment services to be provided by clinicians in the companies; Reasons for which insurance and managed care companies raise objections on specialization of clinicians in the field of post-traumatic stress disorder.

The article reports on the likelihood for behavioral health providers and provider organizations in the U.S. to receive denials from managed care organizations and insurance companies. Prevention is a better approach to denials. When denials do happen, the appeal process is a nice approach to reverse them and get reimbursed.