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CONFIDENTIALITY
IN MENTAL HEALTH
CARE is supposed to be assured by legislation. However
there
are exceptions and you should be aware of these.
The
following situations will affect your ability to control access to your
medical
or psychiatric information.
- If you
are an adult and are
paying the bill
yourself, what you tell your therapist is privileged information and
may not be
divulged without your permission except by court order or to protect
the
physical safety of yourself or others. This
means that if during the session your
therapist becomes concerned that you might be in danger to cause harm
to
yourself or others, your therapist must act in a way to provide for
your
safety. Usually this means contacting a family member to arrange for
hospitalization or to directly have you taken to a hospital emergency
room to
be evaluated further. Besides these exceptions, the therapist is
required to
get your signed authorization before sharing information with any other
therapist,
doctor or family member.
- If
you are using traditional
“indemnity”
insurance coverage and your plan does not have a managed care
“carveout” for
mental health treatment, your insurer will need to know your diagnosis
and
dates of service before paying a claim. While this can be a problem for
some
people, it usually is not: the diagnostic classification systems used
by
insurance companies — DSM and ICD — describe many
conditions in broad,
symptomatic terms and their use does not necessarily reveal sensitive
details
of a patients’ difficulties.
- However,
if your mental health
coverage involves
managed care, the situation is significantly different. Very often your
first
few visits will be authorized without a
“preauthorization” or close inquiry into
your condition. But if additional visits are needed, your therapist
will be
asked to provide treatment reports containing enough detail to (a)
establish
medical necessity and (b) demonstrate that a viable treatment plan is
being
followed. Neither of these concepts, medical necessity and viable
treatment
plan, has a fixed, agreed-upon meaning in the mental health field. As a
result,
managed care organizations can pretty much define them as they please.
On the
other hand, the
therapist will be asked
to provide as much information as is required to procure authorization
for
continued treatment.
- If
you have concerns about what
will or will not
be revealed to your insurance plan or its managed care agents, it is
very
important that you discuss them with your therapist. You are entitled
to put
limits on what is divulged in your treatment reports (though at the
risk of
being denied coverage). Or, to avoid loss of privacy, you may choose
not to use
your insurance at all. Whatever your decision, it is yours to make, and
is best
made after reviewing the options with your therapist.
Remember, the insurance
company cannot determine your
need for treatment. They can only determine if they will pay
for the
treatment. They will usually issue a disclaimer when giving
authorization for
services that states that they are not guaranteeing payment . Ultimately, you
need to decide if the
treatment you are seeking is worth paying for “out of
pocket” in order to
assure confidentiality and continuity of care.
On another note, we cannot be
sure of what will happen
with the information once it enters the insurance database. Some
organizations
have raised questions about whether the fact that an individual has
been
treated for depression might later affect his ability to purchase
disability or
life insurance policies. Other news
sources have noted that the major insurance companies are able to
assign health
scores to individuals based on their utilization of medical services (
in other
words how much do you cost to them) and based on that your Health score
can go
down. Other insurance companies can than know that you are a
“bad risk” without
necessarily knowing your diagnosis. All
of these should be considered so that you can make an informed decision
regarding your insurance.
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