OCD/CBT: Practical vs. Optimal

[socialcog]

Was wondering about your opinions of using CBT (exposure/response prevention) to treat OCD and the practicality/impracticality of it while navigating through managed care.

Managed care favors the traditional 90806 (45-50 minute session). However, I've have found it nearly impossible to adhere to this constraint when you factor in the duration of time to habituate, driving time to and from the exposure and the discussions/processing that follows the exposure. Ideally, I would need at least 2.5 hours to do a 'good' CBT session for OCD.

Thoughts?

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[Therapist4Chnge]

I've got to run, but I'm curious to hear the responses.

-t

 

[michalita]

Was wondering about your opinions of using CBT (exposure/response prevention) to treat OCD and the practicality/impracticality of it while navigating through managed care.

Managed care favors the traditional 90806 (45-50 minute session). However, I've have found it nearly impossible to adhere to this constraint when you factor in the duration of time to habituate, driving time to and from the exposure and the discussions/processing that follows the exposure. Ideally, I would need at least 2.5 hours to do a 'good' CBT session for OCD.

Thoughts?

I think exposure in general takes longer than 50 minutes, and in fact is better in a lot of cases if you do repeated exposures in one long session. I seriously doubt there is any way of explaining that to managed care...

 

[socialcog]

I've heard that managed care prefers brief models such as CBT but there are no procedural codes for lengthy sessions. There is a procedural code for a 90 minute session but I rarely use it and I'm not sure how long managed care will tolerate anything beyond the conventional before issuing their first denials to remunerate.

Dealing with managed care is seriously the worst part of our business.

 

[Therapist4Chnge]

Yet another reason why people are going to cash practices, and abandoning insurance. That is my plan, but I don't plan on doing more than 6-8 sessions per week.

-t

 

[PsyKardinal]

Yes managed care can be difficult to work with especially when treating issues that require a lengthy amount of time or very involved work. My focus is a 70/30 based practice, where I can get the pt's to move over to cash based. In working with managed care, the will pay for 90806's and usually a variety of other CPT codes that are approxiametly same length of time, such as group or family therapy.

My suggestion is this when you negoiate your rate with the insurance company you work hard to negoiate a good rate for yourself. Then during the cert proces to get your work precertified and/or paid for, have your game face on. Top 3 suggestions to get paid.

1. Know your client and their presentation. If you can not answer simple questions about how you arrived at a diagnosis, no one at insurace company is going to believe you have any idea about how to treat the person.

2. Know how to treat your patient's problem effectivly. Supportive hand holding is not going to be paid for. They want to see progress, move the patient forward. Make sure that the progress is measurable, use verifiable criteria. Example a depressed patient, use the Beck Depression inventory.

3. Recognize that more often then not the person you are going to talk to at the insurance company falls into one of two categories. First a customer service person that knows nothing about clinical issues. 2nd a licensed professional that is going to ask tough questions. Be ready to handle both.

4. Appeal appeal and appeal if you are denied. In your paperwork with the Pt at the intial session make sure you have this line. "Patient is responsible for payment of services rendered, regardless if insurance pays for the claim or not" or some variation on that language.

Jeff

 

[socialcog]

Yes managed care can be difficult to work with especially when treating issues that require a lengthy amount of time or very involved work. My focus is a 70/30 based practice, where I can get the pt's to move over to cash based. In working with managed care, the will pay for 90806's and usually a variety of other CPT codes that are approxiametly same length of time, such as group or family therapy.

My suggestion is this when you negoiate your rate with the insurance company you work hard to negoiate a good rate for yourself. Then during the cert proces to get your work precertified and/or paid for, have your game face on. Top 3 suggestions to get paid.

1. Know your client and their presentation. If you can not answer simple questions about how you arrived at a diagnosis, no one at insurace company is going to believe you have any idea about how to treat the person.

2. Know how to treat your patient's problem effectivly. Supportive hand holding is not going to be paid for. They want to see progress, move the patient forward. Make sure that the progress is measurable, use verifiable criteria. Example a depressed patient, use the Beck Depression inventory.

3. Recognize that more often then not the person you are going to talk to at the insurance company falls into one of two categories. First a customer service person that knows nothing about clinical issues. 2nd a licensed professional that is going to ask tough questions. Be ready to handle both.

4. Appeal appeal and appeal if you are denied. In your paperwork with the Pt at the intial session make sure you have this line. "Patient is responsible for payment of services rendered, regardless if insurance pays for the claim or not" or some variation on that language.

Jeff

All good stuff!! Thanks.

 

[Therapist4Chnge]

Great advice!

-t