President’s Column
by Terry Zenner LCSW (Laf)

LACSW Benefits From Zenner’s Secretary

FYI on the structure of Clinical Social Work Federation:  twice a year the state clinical “societies” (they go by various names) send their presidents to convene nationally.  This constitutes the Board of Directors of CSWF.  Every attendee must be on a national committee or the Executive Committee.  CSWF uniquely calls the latter MANCO, for management committee.  CSWF additionally hires one clerical person and one Executive Director.

The primary focus of this meeting was to vote on three by-law changes.  The first made a whole lot of sense to me.  Somehow they’ve been operating with a by-law that stipulated that it took 75% plus to pass motions.  That was changed to now require a more normal 2/3 majority.  I believe the history of the 25% veto power stemmed from the break-away from NASW’s structure, which leaves little independence for states.  It was an extreme way of protecting minority opinion influence.  A second by-law change also passed.  For the sake of better continuity in members knowing each other, it now stipulates that each state assign a state board member (who may or may not be the state president) to serve a three (instead of two) year term.  These terms will be staggered among the states so that it never happens that the board be mostly first year rookies.  We may have to change our state officer terms of service in our by-laws to accommodate this.  As I write, our state board has not yet decided how to represent Louisiana to the CSWF, i.e., by the president or a different 3 year representative.

A third by-law failed to get a 2/3majority vote.  It proposed “strengthening” the CSWF by giving it authority to impose majority decisions on all states’ societies that belong to it.  The net result would have been to “weaken” the states’ autonomy.  There are pros and cons to the proposed change.  For the time being the pros weren’t explicit or compelling enough to win the 2/3 necessary.

Following on the above, it is apparent that there exists ambiguities in the CSWF structure.  Unlike NASW’s national membership with dues coming down to the states, CSWF gets its funding by dues ($33 per state society member) going up to CSWF.  So some interpret that to mean that CSWF is composed of 26 participating state societies, rather than 4700 members.  Yet CSWF sends it’s newsletter, ACCESS, to all the members.  It’s a technicality that nobody need lose sleep over, but it was news to me so I share it here.

If CSWF had more authority to claim over all states, one of our concerns was that it could then decide national membership dues, and how much it would give back to the states.  That could devastate the budget we assign to lobbying our state legislature, which has been one of our prime reasons for existing.  Yet, just as we value the importance of lobbying, so would CSWF value the ability to specifically lobby for clinical social work issues nationally.  It used to have the membership and money to hire its own congressional lobbyist.  When that became unaffordable, the affiliation with the Clinical Social Work Guild #49 stepped in to allow our borrowing some AFL-CIO efforts.  While the latter has clout, we never were their primary focus (for obvious reasons), and some issues on the state and national level actually revealed positions not necessarily in synch with social workers.

It is an appropriate sequel to report a fourth significant vote that took place.  The CSWF voted to officially sever its ties with the Guild.  Individual state societies and individuals may continue to affiliate with the Guild.  There are a few union oriented states in which there were benefits deriving from Guild membership.  Louisiana is down to two people paying Guild dues.  Renee Cardonne, a social worker who is national President of the Guild, will continue to work with OPEIU and the defunct medical insurers to arrange ultimate payment of claims.  Those people responsible are in direct contact with all of the harmed claimants at this point  They are said to be on a time-table that would have some claims begin to be paid this month (Nov.).

Severance from the Guild means severance from the AFL-CIO lobbyists.  That means to regain the dollars necessary to afford our own national clinical lobbyist/ we’ll have to vastly increase our membership.  Meantime, CSWF has a diluted lobbying influence by virtue of belonging to the Mental Health Liaison Group, composed of 52 various national mental health advocacy organizations.  Among others it includes ABECSW, NASW, and the National Coalition of Mental Health Consumers and Professionals.  Please read the article within citing various professionals’ statistics and what they imply in terms of our need for more members.

The PROFESSIONAL LIABILITY insurer favored by CSWF has changed. Chicago Indemnity remains solvent, but decided to leave that field of coverage.  Taking over will be Philadelphia Indemnity.  For those of you involved in changeover, IF QUESTIONS ARISE , Richard Yanes, Executive Director of CSWF invited your calling him directly at 703-560-4042.

Louisiana Mental Health Perspectives
(very recent figures unless noted)

“I Have A Dream—#4”—Terry Zenner, LCSW (Laf)

Among the hundred or less private social work practitioners who may read this, there is a vast mix of different philosophical as well as practical takes on what each must do to stay afloat.  I personally have chosen the daily risks (and rewards) of operating outside of managed care networks.  I find that my specialization in couples therapy (about 50% of my sessions) decreases the clients’ expectation of insurance reimbursement.  I nevertheless do the paperwork in filing claims for my clients, when an individual diagnosis is appropriate. I have been pleasantly surprised at how many MCO’s do pay for out of network services.  Some, such as Blue Cross, pay as much as 100% (depending on the policy).  BC/BS’s new way of slapping my wrists for not joining their network is to pay the client directly instead of me.  For those clients who haven’t paid me up front as I (and many physicians I go to) now expect, I’m left to trust that they will pay me back.  I’ve never been burnt by clients not doing so, over the past year or so that BC/BS has been playing that game.

Recall a reality from the past that still exists if the therapist is not contracted with the client’s insurer:  the insurer has a contract to reimburse the client for covered expenses that s/he pays in direct obligation to the therapist.  I have this spelled out in the intake paperwork which each client signs in acknowledgement of that legality.

Many MCO’s have a policy of paying 50% for out of network services instead of their more normal 80% for services within network.  That’s a difference many clients are willing to pay as co-insurance in order to go to their preferred provider.  So don’t sell yourself short without testing the willingness of both MCO’s and clients to respect the many years of experience offered by most of us in private practice.

It is my custom to end this column by offering 5 alternative ideas to operating outside of managed care:

16.     Become certified in Howard Markman’s PREP, Fighting For Your Marriage

17.     Become certified in Gary Smalley’s Relationship DNA  (See upcoming workshops, “Smart Marriages)

18.   Consultation to Social Security Administration in reviewing cases of disability applicants

19.  Contract services to adolescent homes

Past President Resigns

Dear LACSW Members,

I wanted to let you know that I have decide to resign from the board of LACSW.  I have been a member of LACSW for 10 years and served on the board for 8 years.  I do plan on continuing my membership.  I still firmly believe in the mission of the organization.

My time on the board has been wonderful.  I have met a lot of wonderful people.  These relationships have enhanced both my personal and my professional life.  I will miss seeing a lot of you.

Please know that I wish all of you the best.  It has been an honor to have served with you.  I hope that the current board and members continue to keep fighting the good fight.  We need people in our profession to make sure that social workers maintain the high standards of practice and are valued members of the professional mental health community.

Best regards,

Treasurer’s Report
 Charlene Spears, LCSW (Laf)

A Familiar Phone Conversation

Therapist:  I’m trying to find someone to speak to about a claim.

MCO Staff:  You’re almost there.  I’m the receptionist who forwards your call to the wrong person.

Therapist:  I’d like to speak to your supervisor.

MCO Staff:  I’ll forward your call.

Mrs. Boudreaux goes to the doctor’s office to collect her husband’s test results.  The lab tech says to her, “I’m sorry, ma’am, but there has been a bit of a mix-up and we have a problem.  When we sent the samples from your husband to the lab, the samples from another Mr. Boudreaux were sent as well and we are now uncertain which one is your husband’s results.  And frankly, it is either bad or terrible!”

“What do you mean?” she asked.  “Well, one Mr. Boudreaux has tested positive for Alzheimer’s and the other for AIDS.  We can’t tell which is your husband.”

Mrs. Boudreaux exclaimed, “That’s terrible!  Can we do the test over?”  “Normally, yes.  But you have an HMO, and they won’t pay for these expensive tests more than once.”

A bit of dark humor from a few years ago tells about the death of the man who invented the health maintenance organization.  He made his way reluctantly to St. Peter, sure that HMO’s would look bad on his final reckoning.

St. Peter surprised him:  “Hey, man!  Welcome to heaven!  Come in!  Sit down!  We’ve got angels.  We’ve got harps.

No one’s ever sick or sad or angry.  It’s great!  You’ll love it!”

“This is great,” the HMO inventor said.  “Frankly, I wasn’t expecting such a friendly reception.”

Our Corporate Sponsor, Synergy, Offers Regional Services

Synergy Healthcare Group offers Inpatinet Psychiatric Services in Baton Rouge and Lutcher, as well as Community Mental Health Centers in Baton Rouge, New Orleans, and Slidell.

Transitional Living services are offered in Baton Rouge and new Orleans, and Home Healthcare Services are located in Baton Rouge, Hammond, Alexandria, Lafayette, and Kenner.

Referral Lines:

Transitional Living: