APA's Managed Care HelpLine recently received a call from a psychiatrist in the Northeast. He was being pressured by a large MCO to join its network. It had recently purchased a smaller network that included 50 of his patients, and he had received several calls asking him to join the larger network. He was warned that when the integration of the two networks was completed (a date that kept being postponed), his patients would be notified that he was no longer in-network if he failed to join in time. The company sent him a copy of the fee schedule it was offering, and the reimbursement was lower than what he was getting from the smaller network (where, by the way, fees had not been increased in many years). He declined to join the larger network, but he called the Managed Care HelpLine because he was worried about exactly what to do. He believed that he'd probably have no choice but to join the new network eventually, but in the meantime, he didn't want his patients to receive the promised notification that he was an out-of-network provider.