For many health care consumers who have changed to managed care, their initial reaction was fear of the new controls on how they would get their health care. Individuals with disabilities have these same concerns, as well as some additional concerns. Because many individuals with disabilities need special health care services, they feel particularly vulnerable to the controls and structure of a managed care environment.

For most consumers with disabilities, their doctor or psychiatrist is their principal contact with the managed care organization. As a result, you can ease many of their fears and concerns by talking with them about their needs and expectations in a managed care system.

Changing to managed care is made easier for individuals with disabilities if providers and health care plans recognize and address concerns that have been openly expressed. Individuals with disabilities who enter managed care organizations are often concerned about:

• Choosing new doctors/losing their current doctor or psychiatrist (for people with behavioral health needs). Being cut off from their specialist.

• Seeing new providers who may not be familiar with their needs or disability. Not knowing where to go for help or who to talk with in a managed care system about problems.

• Facing limitations on necessary therapies and other benefits.

• Not receiving authorization for services or equipment (or repair of equipment) that they rely on for independence and maintenance of functioning.

• Determining whether the managed care organization (HMO, PPO) will have the appropriate structures, flexibility, and/or benefits to meet "non-typical" needs.

• Determining whether the managed care system will treat them fairly and how their problems can be resolved, informally and formally.

• Being afraid that they will be identified and treated as a diagnosis rather than a person.

• Losing independence of functioning or one's current level of health.

• Not being listened to or valued as experts about their disability and their needs.