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Clinical and Insurance Perspectives on Intermediate Levels of Care in Psychiatry

PLAKUN, ERIC M., MD

Journal of Psychiatric Practice®: March 2018 - Volume 24 - Issue 2 - p 111–116
doi: 10.1097/PRA.0000000000000291
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This column compares a clinical perspective on the continuum of care for mental health and substance use disorders with a different perspective derived from publicly available insurance company documents and experience dealing with managed care utilization reviewers. The latter perspective tends to determine the need for access to levels of care based on the need for crisis stabilization, whereas the generally accepted clinical standard is more nuanced than the need for crisis stabilization alone. The column proposes that this discrepancy in perspectives makes a substantial contribution to disagreements between treating clinicians, such as therapists, and insurance utilization reviewers concerning the medical necessity of various requested levels of care.

PLAKUN: Associate Medical Director, Director of Biopsychosocial Advocacy, Austen Riggs Center, Stockbridge, MA, and Leader, American Psychiatric Association Psychotherapy Caucus, Washington, DC

The author declares no conflicts of interest.

Please send correspondence to: Eric M. Plakun, MD, Austen Riggs Center, 25 Main Street, Stockbridge, MA 01262. (e-mail: eric.plakun@austenriggs.net).

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