The Mental Health Provider vs the HMO

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By The Shaman


Hello - to give a little background about myself - I am an African-American/American Indian Social worker; a Psychologist and a Christian Minister by trade. I am also into holistic medicine. For nearly all of my life I have enjoyed counseling and helping others in the primary Psychotherapy profession for many years. I have over 25 years of experience in the area and working with others from diverse perspectives leading up to my private practice. I am also a Composer; Artist and am an accomplished Musician. I am known in layman's terms as The Shaman. I enjoyed my practice up until September 2009. Out of the 3,000 clients I have served, and their families from all walks of life I have never come across this level of morally  troubling experience in practice than the one I have recently gone through from the mind of one Patient that I have tried to help - a Patient whom I have only seen four times, but nevertheless took time with. It was one of those encounters from Hell. A month later after we seen her for the last time we got a Certified Letter on Saturday from Optima Health and another one the following Saturday after that regarding a surprising complaint from a surprising source. You see we had taken our time with this memorable Patient; we took time to listen to the issues; gave the objective feedback; done the extensive documentation and included the signature pages and even had eye witnesses of the presence of the same Patient coming to my office, then two months later this same woman filed a false claim that she was not seen by me - at first for all four sessions - then three - then for two. In respect for the complaint the Insurance company asked for documentation and so we complied immediately. Despite the submission of notes;documentation; signature pages and so forth Optim Health's Investigative Team unilaterally sided with the Patient who has some serious issues surrounding the need to control. The Patient even bragged to me about her control over the investigator the case was assigned to this case stating that she is her ''BITCH'' more than once. Believe out there I am not making this up! I then shared this sentiment with UBH Provider Relations and Optim Health in many a letter of complaint that I sent everywhere since I was not allowed to talk to the Supervisor of this naive investigator directly. Unfortunate for me they still of course stubbornly and humorously backed the hasty investigator's prejudiced decision. I guess to save her face. We recalled the only two conversations we had with this female investigator who has no clue of the kind of work we do; no appreciation and has not respect for mental health professionals ; the profession itself telling how she has decided in this case and her team. She was found to be already well armed with a jaded attitude against all doctors; social workers like me and psychologists thinking that only the Patient is right in ALL case disputes. No one should make blanket judgments She lacked understanding of the seriousness of the work and the kind of diverse people we encounter. She fails to understand that not of us are automatically frauds and white collar criminals when a someone files a claim against us. Some of us are still honest hardworking dedicated people. I have sustained over a month of certified letters, the last one from them I refused to sign over $40.00 dollar claim in outrage from the overbearing handling of this case. For Practitioners like me in this sort of situation there is no guarantee that this client will not stop until all the $120.00 worth of paid sessions are recouped. To Optim Health - the Provider has no rights - you can appeal but you know in your guts that they would just uphold a bad decision and judgment call. What hurts most is that the client is an active child abuser; and though she is a Teacher by trade working with Autistic children she is abusive; she is an abusive person in personality who is likely getting away with far more than this practitioner will ever claim and ever had been accused by her. Because of the ill decision made by one hasty novice investigator this Patient will get far worse psychologically for the next doctor she will meet because of this hollow private ''victory'' that allows her to have a taste of power and control. Abuse comes in many forms and not in always from the usual places. Besides that because of this bad economy being in Private Practice is even more risky because of mean Patients like the woman I met - especially when Insurance Companies prefer to listen to false allegations against someone despite the evidence and cooperation of the Provider just to get back $40.00! Now this is what I call extreme economics in extreme Health Care Practice.

So beware Practitioners and others too eager to help everyone. Don't be -especially if they come from this HMO/UBH/EMPIRE/OPTIM HEALTH. That next Patient could mean the end of you - so to speak. I invite you to share your experiences with HMO's like Optim Health from the perspective of a Mental Health Practitioner. Hmm I wonder if there are more Professional ''victims'' out there. Am I the only one that has experienced this?? Speak Out!


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