President’s Report
By Terry Zenner

Your Board of Directors met in April, as it does approximately every two months. I mention this as concerns your possible interest in becoming a board member. This invitation stands no matter where you live, or how you’re enrolled in the LACSW. We can always utilize fresh perspectives. Please consider joining us for a two year term to test the waters. It is an honor and a responsibility that is rewarded by lively discussions that keep all of the board up to date with statewide issues. Call me at 337-989-9350 for further discussion.

While I still have your attention I want to share a reflective thought. I have personally been bored by newsletter editors who seem to only fill the pages with gratitude to various individuals. After two years as President and newsletter editor, I am only now realizing that this is about the only opportunity to get the word out to the whole membership about the invaluable job that individual members contribute. Were it not for this format, such effort might go entirely thankless, save for a private expression of appreciation. That would not be right; so take a glance at the list of board members to the left. I ask that you express a word of thanks to each of them that you may know. You can book it; if they’re on the board, they have done many things in your behalf. Though some board members may second guess whether they’re noticed, I know that each of them would still not give up their investment in LACSW. It’s that internally gratifying and socially rewarding to discuss and make decisions that affect social workers and their clients. If this were hype, we wouldn’t have board members who have served over 10 years. On the other hand, many deserve a rest. Please give serious thought to stepping up to the plate for an at bat.

Central to the April meeting were legislative concerns. We were joined again by a nursing representative/participant among a coalition of some 400 varied professionals working toward prompt pay of insurance claims. To that end it has been decided to this year focus on prompt pay’s precursor, a “clean claim”, defined in advance. This alone would remove a lot of LCSW headaches involved in HCFA’s being sent back and forth. As always, there remain likely hidden barriers to fulfilling this goal. Yet it is nice to be working with fellow professionals who are astute enough to appreciate that all progress in the legislature happens piecemeal.

We are looking for case examples to “put a face on the problem” of unending payment delays. Legislators are more apt to listen to a constituent’s emotional story that to theoretical statistics. You are a constituent of some legislator. Help us help you by coming forth. If you would be willing to share such (with client confidentiality, of course) please call our LACSW legislative committee chair Deborah Fernandez, at 225-767-2106.

For you information, Louisiana law currently states that insurers must pay electronic claims within 25 days and paper claims within 45 days. The law has no teeth, and a primary tactic used by insurers is to delay around the definition of a clean claim. (cont. p. 3)

LACSW has the ear of the Attorney General’s office concerning companies that claim they need not pay claims because their headquarters are not in Louisiana. We have three cases specifically cited to demonstrate the problem. Again, we are looking for more examples from various companies who use this tactic, as each one requires a unique legal approach. Please call me (T. Zenner) at 337-989-9350 with any such ASAP.

Aside from dues, LACSW secondary income stems largely from sponsoring workshops. The March workshop in Shreveport by Darryl Ducote on Gottman’s approach to marital therapy brought in a net of approximately $1,000. So many thanks are due to Darryl, a past president of LACSW, who donated his time for a minimal compensation. Big kudos also to Leesa Sitter, Skip Morlier, and Mimi Jalenak. There will be a repeat of this same workshop at River Oaks Hospital in New Orleans on June 17, 2005. See the registration form within this newsletter. Please join us in New Orleans for the content and presentation that got raves in Shreveport.

Marjorie Roniger did a thorough job of writing up the minutes in her debut as the new Secretary for LACSW. She actually was subbing for Leesa Sitter, who has been taking board minutes for umpteen years...no one really knows how long that has been or how to write that number. THANK YOU is inadequate. Leesa will remain on the board in charge of managed care issues. Marjorie will officially become Secretary 7-1-05 and will also serve with Leesa on the Managed Care Committee. On that date Judy Haspel will become President of LACSW and Carol Miles President-elect.

  I Have a Dream….The Demise of Managed Care
       By Terry Zenner 

As my parting encouragement of your divorcing managed care, I (personally, not as an LACSW position) offer below a form letter I developed and sent to such corporations, beginning about 6 years ago. I have since rid myself of all of them. Feel free to copy, edit, and use it in any way you might wish. 

Dear Any Human (if you have one):

This is a legal document. Please read it thoroughly.

I am twenty-six years out of graduate school and have been an active clinical social worker through those years. For the past twelve years I have been in private practice. I gave Managed Care a full-fledged effort since its inception. At one point, I was dealing with forty Managed Care companies. I have come to the sad conclusion that there is a generic character fault in "the Managed Care way." The preponderance of M.C. companies truly couldn't care less about quality of service. M.C. is focused on one thing: this month's bottom line.

As a mental health professional, I must first take care of my own mental health. It is disheartening to push more and more paper for less and less money. I won't allow you to do this to me anymore, though I know you'll do it to your own employees and my fellow practitioners. I am selectively weaning myself of M.C., and you didn't make the cut for reasons checked below:

( ) A. I grew weary of credentialing, recredentialing, and re-recredentialing as you failed to honor a lengthy application previously submitted to you or your newly purchased subsidiary. (We're not talking here of legitimate updates of licensure and insurance proof).

( ) B. You have widdled your reimbursement rates to an unacceptable return on my investment. You can't afford me, and I can't afford you any longer.

( ) C. Your required paperwork borders on the absurd. I've grown weary of working for your company on my weekends.

( ) D. On a good day it literally takes me close to five clock minutes to get through your levels of voice mail to reach a human being, or even to just leave a message. I suggest you try calling your 800 # sometime when you're feeling chipper.

( ) E. Your contract interpretation would warrant hiring a lawyer. I don't have a legal staff.

( ) F. You essentially say we'll only pay you for X sessions, but you do what you think is professionally necessary at your expense.

( ) G. I am a professional, not a "provider" of a product on an assembly line.

( ) H. You are a conglomerate that has gotten "too large to be efficient". (Stanford Univ. economist Victor Fuchs)

( ) I. I have yet to receive a referral from you. (I was actually told by one company that this was because of my name's alphabetical placement; a real quality determinant!)

( ) J. I picture your office as typified in the Dilbert cartoon. A recent corporate client said he stopped reading Dilbert. It wasn't funny to live it. Are you living it? I'm not. For those of you who have little choice, I'll pray for you.

( ) K. I’ve actually had very little contact from you, but your reputation precedes you. I’ve read too many negative comments, or heard other therapists' comments about your particular company and want no affiliation with it.

( ) L. Rather than being a managed care company, you are an EAP who has begun operating as a managed care company; limiting usage of the employee's prepaid sessions to less than what the employees had been informed. In the mental health profession, this is commonly referred to as "crazy making behavior." It is good for neither me nor my clients' mental health.

( ) M. I've been sending out variations of this letter for six years. My parting at this point is generic; you simply fall in the category of being among the last of the MCO's of which I am ridding myself.

I feel uplifted for going about this. You'll continue to have starving rookie practitioners who need you, suffer through you, and pass on their discouraged professional selves to their clients. The latter, because of this, will not get the exuberance and zest they deserve in a psychotherapist. The effect of M.C. is depression and disappointment, not exactly what you are telling employees in brochures.

I once left a mental health center job because it wasn't mentally healthy. Blame went to the state capital/ civil service bureaucracy, and the psychiatrists' answer to too many solvable problems was a pill. This was in 1976. Substitute your company for the above 3rd parties and nothing's changed. Now, I choose once again to be accountable to my clients, my peer supervision group, and myself. We'll do just fine. You see, I market integrity, reputation, and some years of wisdom. These are invaluable. They have nothing to do with your bottom line, nor mine, nor paperwork. Don't read this as arrogance. I'm humbly taking my vulnerable chances and have yet more life lessons to learn. Remember this letter. Pray for me, and I'll pray for you.

It is a sad day that it should come to this. It is also a happy day: kind of like getting hit over the head with a hammer. It feels good when it stops. I object to the terms of your contract as it stands, and HEREBY RESIGN as an affiliate in your M.C. and/or EAP panels effective _________. It would be business-like of you to acknowledge this letter in writing. Without such I will consider your signed receipt of this certified mail as the same. I presume you'll not route new referrals to me during this period because I can no longer be "gagged". May your outcomes be good ones, and your quality always be assured.

Sincerely,

Terry J. Zenner, MSW, LCSW

P.S. You were sent this very same letter on July 20, 1998. Typical of managed care companies, you have continued to carry me as a provider when clearly you knew better, or should have.

Welcome or Welcome Back
since 1/1/05!

Make a donation today

to the:

 LACSW PAC

c/o Justin Schleis

5425 Brittany Drive, Ste. A

Baton Rouge, LA  70808-9170

     Balance Sheet 4/1/05

Account                                     Balance Sheet as of 4/1/2005

Schedule of the LACSW Board Meetings:

Fridays, 10:00A.M.- ~ 2:00P.M.

Behavioral Hospital of Baton Rouge

August 12, 2005

Any member is welcome to attend. The meetings always expand knowledge of what’s happening in many domains of social work. It’s a good way to taste whether you might want to commit to being a board member.

If interested, call for directions:

337-989-9350 (Terry Zenner)

(All members in attendance at the June 17 workshop will participate in voting to elect board members and new officers.)

1. Don’t tell people everything you know.

2.

It’s all in the punctuation:

An English professor wrote words, “Woman without her man is nothing” on the blackboard and directed his students to punctuate it correctly.

The men wrote: “Woman, without her man, is nothing.”

The women wrote: “Woman: without her, man is nothing.”

WORDPLAY

How confusing is English to learn?

1.        We have to polish the Polish furniture.

2.        How can he lead if he can’t get the lead out?

3.        A skilled farmer sure can produce a lot of produce.

4.        The dump was so full it had to refuse refuse.

5.        The soldier decided to desert his dessert in the desert.

6.        No time like the present to present a present.

7.        The white dove dove down into Dover.

8.        I spent all of last evening evening out the pile.

9.        They were much too close to the door to close it.

10.  After a number of infections, my jaw finally got number.

L.A.C.S.W.
Louisiana Association of Clinical Social Workers
 

Presents:

Darryl Ducote, L.C.S.W.,
B.C.D.

The Research-Based Marital Therapy
Of John Gottman, Ph.D.

Friday, June 17, 2005
8:15am-4:30pm

at

River Oaks Psychiatric Hospital
1525 River Oaks Road
In New Orleans, LA

6 Hours of Continuing Education Units

This presentation is intended for Licensed Clinical Social Workers, Licensed Professional Counselors and Licensed Marriage and Family Therapist. All other interested professionals and students of these professions may contact the workshopcoordinator for attendance.

Registration Form in PDF format

Managed Care Update
by Leesa Sitter

Our President, Terry Zenner, reports we should hear back within the month on our request for an Attorney General’s opinion on out of state insurance companies covering lives in Louisiana and stating they are not bound by the same laws. Social Workers are still having difficulty with BC/BS of Alabama stating their provider panels only cover M.D.’s & Ph.D’s. This was a problem in the past with BCBS of Texas, but after researching further many products do include social workers, and some use panels established in Louisiana.

Toni Cookson with U.S. Dept. of Health and Human Services oversees self-insured plans and can be contacted at 214-767-6831 ext. 283l.

Please fax managed care concerns or helpful hints to pass along to my attention at fax # (318) 226-8754.

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 Mental Health Spending — from Richard Yanes, E.D. of CSWF

In a report issued in March, the U.S. Department of Health and Human Services (HHS) estimated in 2001 that 63% of all mental health spending came from public sources compared to 45% of spending for other health disorders. Among the public source payers, Medicaid was the largest source of funding, accounting for 27% of the mental health spending. And more than half of the public dollars spent on mental health are managed by the states and local jurisdictions.

Private insurers accounted for only 22% of all mental health expenditures while out-of-pocket payers accounted for 13%. Hospitals received 27% of the total mental health expenditures splitting the funds with general hospitals receiving 58% and psychiatric hospitals 42%.

Of the total mental health expenditures, $85 billion in 2001, 21% went to retail drugs, 21% to physicians and other professionals, 18% to multi-service mental health organizations, 16% to general hospital, 11% to specialty hospitals, 7% to nursing homes and home health, and 6% to insurance administration.

From 1991 to 2001, private payers for mental health services declined from 43% to 37% of the total expenditures, which totaled $49 billion in 1991. Not surprisingly, the greatest growth during the decade was in retail prescription drugs accounting for 39% of the increase, physicians accounting for 14%, while other professionals increased by only 6%.

For a copy of the report, National Expenditures for Mental Health Services and Substance Abuse

Treatment 1991-2001, contact the Substance Abuse and Mental Health Services Administration (SAMHSA). Their web site is www.samhsa.hhs.gov.

CONTACT YOUR LEGISLATORS

Online: www.senate.legis.state.la.us
Click on “Find Your Senator” and type in your address.

Email addresses available at:

By telephone:

By Mail:

In person: To get to the Capitol, take Capitol Access Road exit from Interstate 110.

The Good: A member in Kansas has bequeathed $29,000 to CSWF.

The Bad: Colorado has withdrawn from CSWF.

The Ugly: We’re not going to go there. Life is beautiful.

FYI:

As of 4-1-05 UHC will send payments directly to patients if you are a non-contracted provider. (BC/BS of Louisiana does the same.)

TOO MUCH INFORMATION:

Mating soapberry bugs remain locked in embrace for up to 11 days, which exceeds the life span of many other insects.

LACSW
P.O. Box 14153
Baton Rouge, LA 70808
Phone: 225-761-1668
Fax: 337-989-8458
Email: LACSW2@hotmail.com

Reminder: Please go to our website, www.lacsw.org to update your data. This is free publicity for your practice.

Our Special Thanks to Behavioral Hospital of Baton Rouge for hosting LACSW's meetings.

Behavioral Hospital of Baton Rouge
440 North Blvd.
Baton Rouge, LA 70806

Inpatient Admissions: 225-343-1994 or 800-215-0108

Moving? Missed an Issue?

Please contact us at:

LACSW P.O. Box 14153 Baton Rouge, LA 70808
or
lacsw2@hotmail.com

To Contact Your Licensing Board:

Send $5.00 to the board for a copy of “The Rules, Standards, and Procedures of the Louisiana Social Work Practice Act– amended Oct.24, 2003.

Louisiana State Board of Social Work Examiners 18550 Highland Road—Suite B Baton Rouge, LA 70809 Phone: (225) 756-3470 or 800-521-1941 (LA only) email: socialwork@labswe.org Website: http://www.labswe.org

Contact Information:

LACSW Officers:

President– Terry Zenner 337-989-9350

President Elect— Judith Haspel 504-891-5807

Secretary— Leesa Sitter 318-226-8753

Treasurer— Charlene Spears 337-237-9150

Regional Board

Baton Rouge - Anita Evans, Deborah Fernandez, Judy Holland, Maureen Powell, Justin Schleis, Larry Gooch

Covington— Carol Miles

Lafayette - Connie Konikoff

New Orleans– Anne Heard, Mimi Jalenak, Donna Lewis, George Morlier, Laura Myers, Marjorie Roniger

Shreveport—  Peggy Salley

Slidell— Maria Klette-Ketchum