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California Psychiatric Association Documents
What Should You Look For In A Health Plan?
Questions and Answers


If you have health insurance the chances are increasingly high that your insurance carrier either contracts with a managed care program or provides some type of utilization review of your care. It is to your advantage to be well informed about managed care as it has significantly altered the traditional delivery of health care services, particularly in the area of mental health.

Frequently, in the midst of crisis or a health emergency it is difficult to analyze the terms and conditions of a health insurance plan. This pamphlet has been developed to provide a brief survey of things you should know about managed care. We do not pretend to cover everything, but the following may be helpful.


Questions and Answers For The Consumer Of Mental Health Services

How Do I Know What Is Covered By My Plan?

Do I Have A Choice Of The Mental Health Provider I See For Evaluation Or Treatment?

Whom Do I See First?

Is The "GateKeeper" Always Qualified To Assure That I Have Had An Appropriate Evaluation And That I Am Getting Appropriate Treatment?

How Can I Be Assured That The GateKeeper Has The Right Training And Background For My Problem?

What Happens If The Initial Diagnosis Or Plan Of Treatment Isn't Appropriate?

How Can I Be Sure That My Emotional Problem Isn't Being Caused By An Underlying Physical Problem?

What If I Think My Situation May Require Medication? 

What If The Treatment Approach Agreed Upon By My Provider And Myself Is Denied By My Plan?

What If My Treatment Plan Is Ultimately Denied Despite The Appeals Of My Provider?

Is What I Do Or Say In Treatment Confidential?

What Do I Do If I Am Dissatisfied With Some Aspect Of My Plan?

California Psychiatric Association DISCLAIMER
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