Reflections on Managed Health Care

Posted on May 10, 2023 by Barbara Beck-Azar, One of Thousands of Christian Coaches on Noomii.

In May of 2012, I completed a life coaching certification that would allow me to help others with personal, business, or other life issues through the art of coaching. This followed quitting my ten-year career as a business and sales development manager, where most of my time was spent doing precisely what the coaching certificate promised. Needless to say, finishing the course left me with more questions than what they provided as to how one successfully coaches without knowing psychology and counseling methodologies. By September of the same year, I entered college with the aim of becoming a licensed counselor, along with gaining enough knowledge plus experience that is supervised to know what I was doing. Besides, licensing ensured that I could also help clients who had insurance along with payments from those who preferred paying fees with cash, check, or credit. While researching counseling in the marketplace, the results were less than dismal and quite discouraging regarding salaries, payments, and insurance regulations on mental health care as a provider.
CURRENT MANAGED CARE
Today, America is experiencing a crisis of epic proportions in both in physical and mental health. My personal experience with a therapist started when she accepted insurance co-payments. Still, then she went into private practice charging far more than any student can afford who is not employed. I felt much like when Schneiderman (2018), who writes for Psychology Today, expressed about her experience of not being able to afford her therapist’s leap from managed care into private practice fees. Paying for excellence in mental health care is a double-edged sword in that seasoned therapists charge high prices as they should, but those in precarious positions who cannot afford those fees end up without care or find beginning therapists.
Schneiderman summarized the fee, payments, and insurance dilemma like this: “As long as insurance companies continue to underpay and over-complicate the professional lives of psychotherapists, those seeking to pay for behavioral health with insurance may find themselves choosing from a narrowing pool of less experienced clinicians (Schneiderman, 2018).” Now that I am nearer to completion of graduate school in counseling, wrestling with the realities of being underpaid for such lengthy studies on how to help others made me apprehensive about the profession of counseling. She also stated that the amount of paperwork required by insurance companies nearly buries the counselor with wasted forms, such as the Blue Cross Blue Shield – New Mental Health Practitioner Enrollment Form (2018). If there are 12 pages for enrollment, imagine the documents needed for every client!
Surely there must be a way out of a boxed industry that insurance and government have health care providers jailed into in modern times. Both therapists and clients must figure out an alternative to the vicious cycle of earning that allow clients to regain a healthy enough mental state to experience holistic living. One famed existential therapist who gives me hope is Dr. Irvin Yahom, whose books I listen to on Audible daily. His approach and methodology about counseling are worth pursuit because he’s lived it for decades with great success. No matter the pay-scale or restrictions, he sheds light for all therapists to pursue their authentic calling to help others.
Jones (2008), wrote about the many challenges facing all therapists beginning or experiencing and is encouraged with some changes in that NYC finally acknowledges that “long-term psychotherapy is a must for some people to be healthy and is not just palliative care for the neurotic.” She quoted Nancy Levine, LICSW, who stated, “I think that managed care flies in the face of the social work Code of Ethics because it really doesn’t acknowledge what is at the heart of social work: the importance of relationship.” My feelings exactly because the past six years of study drilled into my brain that relationship is everything when becoming a counselor. We, as counselors, must always advocate for the clients no matter what restrictions come from insurance companies, which means making sure the client can afford a fee via a sliding scale.
My Impressions about the Field of Counseling
My training in Life coaching promised skill sets to help clients find healthy ways to overcome obstacles in life while at the same time offering coaches incredibly high incomes. Yet, coaching did not provide me with enough background or knowledge to help people in all areas with enough comprehension of people’s psychological needs. A graduate school degree needed to become a licensed Counselor, on the other hand, costs a fortune in student loans and promises minuscule salaries along with being strangled with regulations, restrictions, and additional assorted fees to say currently.
When working as a manager for a company that paid an excellent salary with benefits including a car, I had opportunities to help others without restriction, making time for individual consultation, group meetings, workshops, newsletters, and so many avenues for building others up in knowledge, skills and becoming strong within themselves. That freedom allowed me to help others no matter their status in the business and even those not connected directly with the company while being paid. I thrived not only in social relationships and business but earned top awards that allowed me trips overseas, cruises, and bonuses due to the freedoms awarded by helping others become successful.
Indeed free-market-based ways of doing work offer more creative alternatives as opposed to being under the thumb of government or health insurance industry standards. Sadly, there are no easy answers for those without experience or license in the workplace or knowledge of free enterprise to outmaneuver such realities. Somewhere there must be a balance or meeting place in thinking about how to find work that pays the bills while practicing as a counselor. Writing books, giving workshops, and speaking engagements that provide residual incomes seem quite a no-no to the Academic or ACA standards for counselors. Reform needs to go deeper than just insurance companies, legislation, and government, but into entities that oversee the field, including education academics.
My Future Plans
Any articles about the current state of affairs in the counseling profession reflecting the issues between insurance, low fees, and restrictions burst many bubbles but did not leave me entirely without hope. These questions helped me decide not to take a dual concentration of therapies at Edinboro. My creative endeavors in fine art and graphic design are already a source of income that can be used as work or supplemental income in the future, no matter what counseling consequences offer. I confidently know my skillsets, motivational drive, and talents no matter what the industry does or does not provide concerning employment with the knowledge that I will be successful in anything I put my hand to for work, even in counseling.

References
Blue Cross Blue Shield. (2018). WF-10575. Retrieved November 5, 2018,
Jones, L. K. (2008). When managed care coverage runs out — Effective, ethical solutions.
Great Valley Publishing Company, Inc.
Schneiderman, K. (2018, April 3). To stay or not to stay in managed care