Bravo to the physicians for speaking against the upcoming cuts in Medicare reimbursements and the threat of refusal of accepting more patients in their medical practices. How come mental health professionals can’t follow this same pursuit?
Our profession has a big white elephant in our presence for refusing to speak out against cuts in payments for providing mental health services to our clients.
I will give you an example on what I am talking about. Two years, one big powerful health insurance company in Central Massachusetts cut reimbursements from $ 55.00 to $ 50.00 for providing mental health services to their clients. There are two things wrong: 1) Why on earth are mental health professionals taking their clients for low pay? 2) Where is the threat from the profession to stop taking their clients when the rate dropped to $ 50.00?
I have more pet peeve with this provider. Last Spring, they implemented a new conversion of billing claims with their contracted provider to pay mental health professionals. It has been a nightmare in getting paid on time. From June to November, I called the contact in provider relations to complain that I was not being paid for my services. Due to my constant telephone calling on a weekly basis, I was paid for one claim in October after I saw the client in April. In November, I was paid for two claims (after being overpaid twice) after I saw the client in June. As I write this blogpost, I am still have not been paid for ten claims since September to October due to their billing company losing the claims and my bookkeeper having to fax the claims to their supervisor.
Isn’t this ridiculous and insult to injury to fellow counselors?
Regarding low reimbursement rates, this health insurance company does not value the work that we do in our state. I am very disappointed with the leadership from both the mental health counselor and social work association for not speaking out on these two issues.
Regarding this horrible billing system, many complaints have been noted on their annual feedback form that the health insurance emailed to use to fill out this year.
You may ask why we continue to take their clients. There are two reasons: 1) In my area, many companies have switched from Blue Cross to this provider who have cheaper rates. 2) Getting private pay clients is not happening. In fact, many working families are now on the state medicaid system due to not being able to purchase an affordable health insurance commercial program.
What can we do about these issues?
1) The state social work and mental health counselor association need to speak out against this insulting low reimbursement rates.
2) They also need to meet with this provider to negotiate a high reimbursement rate to accept their clients.
3) If the above two tactics don’t work, then I advocate that the two associations call for a statewide boycott of accepting more clients from this provider.
I don’t know if the velvet glove approach will. I welcome your comments.
Saturday, December 4, 2010
Saturday, October 23, 2010
Is Blood Thicker Than Water?
I heard about a very sad event that an adoptive single parent endured this past week. She had to relinquish her 17 month old preadoptive son from the state foster care system to his biological father. Apparently, the birth mother told the state who the father was after a year in which she refused to identify him at birth. The birth mother held back the information due to her belief she would get custody back of her baby after she cleaned up her act in a drug rehabilitation facility. When the birth mother found out her parental rights were terminated this year, she decided to identify the birth father so she can still see her son in his custody. What a tragedy for this parent and for this baby.
How did this happen? In Massachusetts, the foster care/adoption system runs a little differently as opposed to doing a domestic adoption from a licensed agency. For the former, there is no system in place to post announcements in public newspapers that call birth fathers to identify themselves during the adoption hearings. For the latter, this system is in place. If the birth father does not show up during an adoption hearing, his rights are terminated.
As a counselor, I believe that the foster system for preadoptions is broken. I have heard of other similar cases where children were going to be adopted by their foster parents and liberal judges painfully tore them away and placed them with biological relatives who came out of no where. This dysfunctional process hurts the attachment bonds between the children and preadoptive parents. The slogan, “ Blood is Thicker than Water, “ is bogus and harmful to preadoptive families.
In 2005, I taught a class to non-traditional students entitled, “Functional Families,” which defines families as a group of individuals living together and establishing healthy bonds regardless how they were formed. This definition needs to be taught to judges and lawyers who create outdated laws that hurt adoption options for families who want to be parents.
What can the counseling profession do about it? We need to be vocal in educating lawmakers about antiquated laws that say a family is made by DNA only. We also need to promote equal laws and processes for both the foster care and domestic adoption systems in your state.
Counselors can educate legislators about the broken attachment bonds that can develop between a child and adoptive parents when their adoption is “interrupted” and a child is forced back with their biological parents. Massachusetts promotes unhealthy families when they reunite children with their biological parents who are not capable of parenting them. This policy goes against the mission that both the social work and counseling professions hold in promoting healthy development and growth and the fullest potential in individuals and in families.
We can do something as a collective to make positive changes.
I welcome your feedback.
Robbin Miller
Moderator
How did this happen? In Massachusetts, the foster care/adoption system runs a little differently as opposed to doing a domestic adoption from a licensed agency. For the former, there is no system in place to post announcements in public newspapers that call birth fathers to identify themselves during the adoption hearings. For the latter, this system is in place. If the birth father does not show up during an adoption hearing, his rights are terminated.
As a counselor, I believe that the foster system for preadoptions is broken. I have heard of other similar cases where children were going to be adopted by their foster parents and liberal judges painfully tore them away and placed them with biological relatives who came out of no where. This dysfunctional process hurts the attachment bonds between the children and preadoptive parents. The slogan, “ Blood is Thicker than Water, “ is bogus and harmful to preadoptive families.
In 2005, I taught a class to non-traditional students entitled, “Functional Families,” which defines families as a group of individuals living together and establishing healthy bonds regardless how they were formed. This definition needs to be taught to judges and lawyers who create outdated laws that hurt adoption options for families who want to be parents.
What can the counseling profession do about it? We need to be vocal in educating lawmakers about antiquated laws that say a family is made by DNA only. We also need to promote equal laws and processes for both the foster care and domestic adoption systems in your state.
Counselors can educate legislators about the broken attachment bonds that can develop between a child and adoptive parents when their adoption is “interrupted” and a child is forced back with their biological parents. Massachusetts promotes unhealthy families when they reunite children with their biological parents who are not capable of parenting them. This policy goes against the mission that both the social work and counseling professions hold in promoting healthy development and growth and the fullest potential in individuals and in families.
We can do something as a collective to make positive changes.
I welcome your feedback.
Robbin Miller
Moderator
Sunday, August 22, 2010
Bullying: A Counselor's Perspective
Massachusetts passed a new law entitled, "An Act Relative to Bullying in Schools," in 2010. The purpose of this new law is to "create more positive school climates and age-appropriate instruction on bullying prevention in each grade, and schools must offer information to parents on bullying prevention." (Worcester Medicine, July/August 2010). School personnel (teachers, guidance counselors, aides, bus drives and cafeteria workers) are required to report incidents to the appropriate officials for them to investigate and to take disciplinary actions when appropriate. Bullying includes not only verbal, physical and written repeated acts of aggression and gestures but now includes cyberbullying through electronic means-Facebook; Twitter; Emails; Texting, and through other electronic devices.
As counselors, we see the direct effects on bullying on our clients who come to us with a variety of symptoms:low self-esteem; sadness; agitation; anxiety and fears; nightmares; refusal to go to school; bed wetting; binge eating; and low school performance. Sometimes, some parents just don't know what is going on their with child because their child is either afraid or ashamed to tell them. For a boy raised in a home with a male parent/caretaker being macho and proud and/or culture promoting this environment, he may be afraid to tell him for fear of ridicule or shame. For girls, it may be a little easier due to cultural acceptance to share with their parents/caretakes. However, both girls and boys may be afraid to tell due to fear of being a snitch in school or are facing similar abuses at home where they don't know who to tell or to trust.
I provide my clients a booklet put by the American Medical Association Alliance entitled, "You Don't Have to Be Bullied," (2006) that tells a story of cartoon character by the name of Keith who is experiencing symptoms anxiety and nervousness due to a kid picking on him in school. The booklet provides good and bad choices in handling a bully in school ,and most of all, promoting prosocial behaviors of being calm and cool in dealing with these situations.
However, I need to share with you one caveat that was discussed at a past work meeting this week. Despite teaching our clients to handle bullying in a positive way, a fellow colleague suggested that letting the student punch back the bully would cease it. Honestly, I punched a girl in high school who kept repeatedly taunting me for weeks at a cooking class in high school in the 1980's. The teacher ignored it and my peers did nothing about it. I had enough as I got tired of ignoring it and could not take her hitting me one day in class. I hit her back but the teacher did nothing to stop it. After this incident, the girl became my friend in school. As I look back on this encounter and teach my clients coping skills to deal with a bully, I sometimes find it hard to not agree with their parents' suggestion and my colleague's comment "to punch back" to defend yourself if nothing is done to positively stop it.
What do you think?
Robbin Miller, LMHC
As counselors, we see the direct effects on bullying on our clients who come to us with a variety of symptoms:low self-esteem; sadness; agitation; anxiety and fears; nightmares; refusal to go to school; bed wetting; binge eating; and low school performance. Sometimes, some parents just don't know what is going on their with child because their child is either afraid or ashamed to tell them. For a boy raised in a home with a male parent/caretaker being macho and proud and/or culture promoting this environment, he may be afraid to tell him for fear of ridicule or shame. For girls, it may be a little easier due to cultural acceptance to share with their parents/caretakes. However, both girls and boys may be afraid to tell due to fear of being a snitch in school or are facing similar abuses at home where they don't know who to tell or to trust.
I provide my clients a booklet put by the American Medical Association Alliance entitled, "You Don't Have to Be Bullied," (2006) that tells a story of cartoon character by the name of Keith who is experiencing symptoms anxiety and nervousness due to a kid picking on him in school. The booklet provides good and bad choices in handling a bully in school ,and most of all, promoting prosocial behaviors of being calm and cool in dealing with these situations.
However, I need to share with you one caveat that was discussed at a past work meeting this week. Despite teaching our clients to handle bullying in a positive way, a fellow colleague suggested that letting the student punch back the bully would cease it. Honestly, I punched a girl in high school who kept repeatedly taunting me for weeks at a cooking class in high school in the 1980's. The teacher ignored it and my peers did nothing about it. I had enough as I got tired of ignoring it and could not take her hitting me one day in class. I hit her back but the teacher did nothing to stop it. After this incident, the girl became my friend in school. As I look back on this encounter and teach my clients coping skills to deal with a bully, I sometimes find it hard to not agree with their parents' suggestion and my colleague's comment "to punch back" to defend yourself if nothing is done to positively stop it.
What do you think?
Robbin Miller, LMHC
Sunday, August 8, 2010
Happy Birthday ADA!
Please click on link to my blogpost on www.counseling.org.
http://happy-birthday-to-you-ada-americans-with-disabilities-act
http://happy-birthday-to-you-ada-americans-with-disabilities-act
Saturday, July 10, 2010
The Assembly Line Transformation
Imagine a cartoon of three slides: The first slide is a line of clients in an outpatient office waiting to be seen by a clinician on a Friday. The second slide is the clinician trying to focus but is showing signs of fatigue by yawning and looking at the clock. The last slide is the client leaving the office and the clinician swimming in gold bag of green dollars bills. Read on...
A new trend of how to make money in outpatient counseling services is upon us. Despite new laws to reform mental health services for children in Massachusetts, some agencies and entities are still facing financial losses serving clients on Mass Health. In order to stay afloat, some of these for-profit and non-profit entities are using "carrots" with clinicians to keep their doors open. The new gimmick is to offer financial rewards, for example, $ 500.00 for those clinicians who see a certain number of clients a week, 30-40 for a certain period of time. Honestly, this new incentive is enticing and rewarding, but it is really so?
In my professional opinion, I believe that the quality of offering compassionate and caring services can be difficult to establish on this "new assembly line" business model. I remember the old days when clincians earn decent salaries for seeing 16-20 clients a week which was not so long ago. This caseload is much more manageable for clinicans to have time to do their paperwork properly, take care of their own mental health needs during the day, and most of all, establish healthy workable relationships with their clients.
I ponder the following questions on this new business model:
1) How can clinicians establish quality relationship with their clients if a bag of gold awaits them in the new future?
2)How do you prevent burnout? The answer that scheduling 35 clients a week is not an acceptable answer though it is a cold reality on how to accomplish seeing 30 clients a week.
3) How do you prevent possible unethical behaviors such as fraudlent billing? For example, seeing clients for a half hour and then billing an hour for services?
Isn't time for a healthy dialogue to be established with national associations for social workers and counselors to see this new business model is feasible?
How about clinicians learning how to lobby their legislators to change the way counseling agencies are reimbursed by Medicaid? Please note that agencies don't get paid for no-shows for medicaid clients.
What do you think?
Robbin Miller, LMHC
Facilitator
A new trend of how to make money in outpatient counseling services is upon us. Despite new laws to reform mental health services for children in Massachusetts, some agencies and entities are still facing financial losses serving clients on Mass Health. In order to stay afloat, some of these for-profit and non-profit entities are using "carrots" with clinicians to keep their doors open. The new gimmick is to offer financial rewards, for example, $ 500.00 for those clinicians who see a certain number of clients a week, 30-40 for a certain period of time. Honestly, this new incentive is enticing and rewarding, but it is really so?
In my professional opinion, I believe that the quality of offering compassionate and caring services can be difficult to establish on this "new assembly line" business model. I remember the old days when clincians earn decent salaries for seeing 16-20 clients a week which was not so long ago. This caseload is much more manageable for clinicans to have time to do their paperwork properly, take care of their own mental health needs during the day, and most of all, establish healthy workable relationships with their clients.
I ponder the following questions on this new business model:
1) How can clinicians establish quality relationship with their clients if a bag of gold awaits them in the new future?
2)How do you prevent burnout? The answer that scheduling 35 clients a week is not an acceptable answer though it is a cold reality on how to accomplish seeing 30 clients a week.
3) How do you prevent possible unethical behaviors such as fraudlent billing? For example, seeing clients for a half hour and then billing an hour for services?
Isn't time for a healthy dialogue to be established with national associations for social workers and counselors to see this new business model is feasible?
How about clinicians learning how to lobby their legislators to change the way counseling agencies are reimbursed by Medicaid? Please note that agencies don't get paid for no-shows for medicaid clients.
What do you think?
Robbin Miller, LMHC
Facilitator
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