All ‘medical’ services offered within the context of a ‘medical’ system, are necessarily constrained by that system. The medical system in the US is highly structured. The architecture of that system consists of contractual arrangements and treatment protocols.
One ought not sign contracts that one is not prepared to honor. With HMO’s and PPO’s there are contractual obligations that bind ‘service providers’. HMO’s and PPO’s cite specifically just what services are covered benefits. Then administrative guidelines, including ‘treatment protocols flesh out those terms.
HMO’s and PPO’s in the US are nested within a capitalist economic system. As private companies, they can choose wich products they wish to sell. If I were to open a hardware store I might elect not to sell barbecues. My customers might want me to sell barbecues but I am free to decide to sell them or not. Presently, in the US, particular medical services are not an entitlement. If one wishes to influence this state of affairs, our state and federal legislatures are the appropriate venues.
This is the system within which we (in the US) operate. We must understand the reality of that fact. When signing a contract, ‘service providers’ are agreeing to bill companies only for services that are covered benefits and with a thorough understanding of treatment protocols. Currently, in the ‘delivery’ of ‘behavioral health care’ services, treatment protocols permit ‘service providers’ some degree of latitude to determine the specific nature of services. That degree of latitude is shrinking as, increasingly, behavioral health care treatment protocols are becoming formulated.