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eBook details

• Title: Finding Meaning in Medical Necessity.
• Author : Social Work
• Release Date : January 01, 2003
• Genre: Social Science,Books,Nonfiction,
• Pages : * pages
• Size : 187 KB

Description

More and more of America's employees have health coverage that includes some form of behavioral managed care. Managed care over the past 10 years has resulted in changing patterns of practice. For the most part these changes have been implemented reluctantly (Goleman, 1996; Henneberger, 1994; Hymowitz & Pollock, 1995). Much of the hostility against managed care has been focused on care managers (CMs), who are seen as having sold Out to corporate interests and caring little about human suffering and distress. Care managers have been portrayed as being clinically ignorant, professionally unethical, and personally immoral (Cantor, 1997; Moldawsky, 1997; Sank, 1997). Some express cynicism about the explanations given by care managers for medical necessity determinations, seeing them as disingenuous and just a disguise for an economic decision that managed care will not pay (Walter, 1995). On the basis of literature and our own experience, we have identified six main objections that practitioners raise concerning care manager performance in behavioral managed care. Practitioners challenge the motives of care managers, believing that they are driven by the corporation's goal of making money. Practitioners challenge the morality of care managers who work in health care systems that limit choice and restrict decision making of the member. Practitioners question the professional ethics of care mangers who recommend or dictate changes in practice patterns of other licensed practitioners.

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