It Can Be Done: Essentials For A Managed-Care-Free Practice

By Ofer Zur, Ph.D.

Source: Zur, O. (1998, March). It can be done: Essentials for a managed care free practice. Coalition Report, National Coalition of Mental Health Providers and Consumers, pp. 5-6.

Posted with permission from National Coalition of Mental Health Providers and Consumers.


As we continue to put moral, ethical, legal and political pressures on the managed care industry, there is more we can do to regain control over our practices and to take better care of our clients. After many years of desperately trying to negotiate sessions or argue about ‘medical necessity’ with UR staff I decided to take a different tack. Resulting from my outrage with the immorality of managed care, I have learned to market myself and to consult in a different way from the way I was taught in graduate school or read in our professional literature. In the couple of years that have followed I have developed a full practice which is completely free of managed care and the insurance industry.

The following will outline how one can build and sustain a managed care free practice:

  1. Educate your client about the hazards of managed care regarding confidentiality: Very few clients will choose to use the managed care option, regardless of how cheap it is, if they fully understand the implications for their privacy. During the first telephone conversation I often explain to clients the risk they take when they sign with most managed care companies. I warn them that the most intimate details of their lives may be accessed, broken into, sold, exchanged, or shared without their knowledge or control. I ask them, half jokingly, whether they are ready to take the chance that their “sex lives will be posted on the Internet.” I continue to explain to them that with very few limitations they have full control over information they share with me in a fee for service arrangement. People appreciate the information I give them over the phone, in person, or by mail and regularly find the resources to pay out of pocket for the care of their souls. That should not come as a surprise in a culture that values privacy, they way Americans do. I have a ready made package of articles and brochures detailing the problems with confidentiality that I regularly mail or give to prospective clients, businesses and people in my community. People appreciate my concern about their privacy and respect my strong stance of not caving in to the industry pressures.
  2. Rethink your role as a psychotherapist – Get out of the bed of the medical model: In order to get out of the grip of managed care , we must learn how to also be consultants, guides, wise men and women. Most of the people who seek psychotherapy are neither broken nor mentally ill. They are people who are dealing with the complexities of living in the modern era. The fact that we can give them a DSM diagnosis is mostly a reflection on the medicalization of our profession and our wish to be reimbursed, rather than a reflection of our clients’ condition. We can practice outside managed care if we learn to help people with issues, such as normal developmental crises, (divorce, retirement, grief), love, health, parenting, or vocation and be skilled in working with people intermittently throughout their lives. Arthur Kovacs termed this role the ‘Secular priest.”
  3. Educate people about the hazards of managed care: On a regular basis I describe to people that in most cases the managed care option shifts the control of the treatment from the client and therapist to the company’s CEO and stock holders. I explain that the length, type, quality, privacy, and follow up treatment are often compromised under managed care plans. I mail, fax, or present to people stories from the printed media (i.e Newsweek, N.Y. Times) about how managed care can be dangerous to one’s health or even deadly. In addition to the articles, I present clients with a brochure that I wrote titled: “Beware of your managed care.” It outlines the concerns about conflict of interest, capitation, how providers are being selected or dropped from panels, etc. Again I have found this educational approach to be extremely effective and successful in helping people make informed choices.
  4. Change (your own and) people’s expectations of reimbursements: If we learn how to stop trying to fix or cure diseases, mental disorders, or any of hundreds of ‘name calling’ categories of DSM we can also educate our clients that there is no reason for managed care or any other insurance company to pay our bills. I tell my clients that no insurance company reimburses my accountant, attorney, Rabbi, mechanic, or gardener. Once we dissassociate ourselves from the medical model we are also free of the constraints of DSM and third party payment policies.
  5. Market yourself effectively: Marketing is usually a bad word to most therapists. I have found out that marketing, while usually hard work, can also be fun and respectable. I suggest that we abandon the Yellow Pages or ‘Ego Brochure’ approaches and concentrate on education. People will come and see you if they perceive you as an expert who can help them. The real question about marketing is how to present oneself as a helpful expert. There are endless ways of going about it. One can give (free) lectures or print simple educational brochures on one’s topic of expertise. A lot has been written about how to identify and penetrate a certain niche in the market. Visibility in the community is an effective way of getting referrals as people like to refer to people whom they know and, of course, appreciate. Working with the media, schools, boards of directors, community centers, PTA’s, etc. are all ways of positioning oneself as an expert.
  6. Develop the skills and market yourself specifically to managed-care-free markets: Forensic, mediation, custody evaluation, weight/smoking, chronic illness/health, step-families, parenting, family business consultation, and organizational development, are just few examples of markets which are generally 100% managed care free. Create a vision for yourself, identify the market you want to penetrate, develop a detailed marketing plan, and spend the time and money necessary to execute your plan.
  7. Learn how to exploit managed care to your own advantage: The managed care era provides us with immense opportunities to operate independently. I have discovered that many primary care physicians and G.P,’s refer people to me because they are under capitation contract and they believe that referring to me will get their ‘chronic’ clients off their backs and out of their offices. For this to happen, we must be effective in dealing with chronic illnesses and dis-eases and we must have good rapport with the physicians.

In summary, as we continue our legislative, lobbying, legal, and media efforts we can simultaneously take charge of our practices. Not only it is possible, but it can be fulfilling and rewarding to be faithful to our vocation. We do not need to bow to the managed care gods. If you market yourself well, conduct therapy effectively (not dogmatically), and strategically position yourself outside managed care you can thrive in a private practice which is free of managed care.

Ofer Zur, Ph.D. is a licensed psychologist in Sebastopol, CA where he practices on an entirely fee-for-practice basis. A widely published writer, he has been teaching seminars for more than eight years to therapists on how to develop and sustain a managed-care-free practice. He also has developed a mail order catalog “Essential Resources for a Managed Care Free Practice.” For information about the seminars or catalog call (833)-961-1344, Fax (707) 736-7045, or review information on line at

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