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1. Ask how to schedule a mental health appointment. Call there directly and ask who is on their staff. Make sure that  you're seeing a licensed therapist. If your diagnosis has been problematic, ask who is most experienced.

1. Ask how you can most quickly get therapy within your HMO. It should be a one-step process.  People are often "talked out of therapy" by either being medicated or having their concerns minimized, only to return months later with even more urgent needs. If you have an emotional health need, you should be able to speak to a licensed mental health professional, first. Some HMO's may have your primary care physician push medication as a cheaper alternative, but some of the causes of depression may actually be masked by medication. Being seen by a mental health professional first will provide him or her with an accurate picture of your moods and thinking. Then they can make an informed medication referral.
2. Ask how many total sessions you are entitled to. Many HMO's advertise 20 sessions, but make it nearly impossible to get more than 12.
3. Accept group therapy only if that appeals to you most. For sexual abuse victims, for example, a group might limit greatly their ability to gain the individual attention and safety they need to acknowledge their painful experiences. Ask for individual therapy if you would feel best with that. However, for people who are isolated and lonely, a group can provide a nurturing, supportive experience.
4. Insist on a culturally similar therapist, without having to travel a great distance. HMO's can contract with local minority therapists to provide you with the care you are guaranteed by law. Many will claim that they can't find any, while minority therapists often find themselves excluded from the HMO's referral network.
5. Request confidentiality and security of your therapy records. Ask the therapist to limit personal details in your file. Ask that your case not be discussed with other therapists without your permission.
6. Ask for weekly sessions of at least 45 minutes. Many HMO's give clients sessions at irregular and disconnected intervals, and sometimes give them short mini-sessions. These methods reduce the effectiveness of the intervention.
7. Ask the therapist what she would want done for herself in a similar situation - what services would she seek to improve her circumstances.
8. Be wary if the therapist proclaims you "cured" when you don't feel cured or says that you really don't have a problem when you know you do. Ask the therapist to give you a written evaluation stating why she thinks you are "cured" when you still feel symptomatic. Ask if she has a checklist showing what milestones you have reached. Do you agree that you have reached them?
9. In emergency room situations, if you are told to go home but you still feel suicidal, ask the doctor releasing you to sign a statement stating that you or your loved one will not be at risk of harming yourself or anyone else. This is a good practice in any medical emergency in which you are being told to go home but don't feel well enough to be released.

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In MCO's - the managed care organization has as it's goal, choosing your provider, medications and services that are low cost and generally not above a moderate standard of care. This determination is based on what their panel of "experts" deems as appropriate or sufficient care. They may use standards of care that are not safe or adequate for minority clients. Use your intuition if you feel you are being asked to receive care that does not solve your problem or leaves you feeling at risk. Ask for:

1. A provider of your race if you would feel most comfortable that way

2. A male or female provider if your problem is gender sensitive.

3. Privacy, empathy and confidentiality

4. A one-step referral. You should not have to tell your story in detail more than once. You may be comfortable with saying "I have some relationship problems". They may deny you services if you deny feelings of depression, anxiety, fearfulness, etc. so try to give adequate information.

5.You should not have to tell personal details of your life to   non-mental health providers.

6.You should be able to tell them the length of time you've felt that way and whether or not you felt suicidal (whether your need is urgent).

7. You should be able to see someone within a week. Immediately, if you feel suicidal or homicidal.

Note: We are using this opportunity to warn you about unethical and unfair measures. There are some HMO's & MCO's that do not use unsavory practices and work hard to provide good care to their enrollees. This is not meant to diminish their services. Check websites that measure and compare HMO's based on patient feedback reports and state audits.

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