Insurance Information and Confidentiality

I am a participating provider with a number of health insurance companies including Oxford Health Plans, United Health Care, Emblem Health, Optum/Group Health, Inc. (GHI), Value Options, United Behavioral Health, CIGNA, Empire Blue Cross & Blue Shield, MHN, Multiplan, Magnacare, QualCare, and Aetna/Magellan.  If you do not participate in these plans, my customary fee, which is on a sliding scale, will apply.

When a patient signs a health insurance claim form, confidentiality is, for the most part, waived, so that insurance companies may know if coverage is “medically necessary.”  In addition, at times telephonic reviews are conducted by the insurance companies (with me) in order to approve or authorize ongoing sessions.  The trend in releasing information to insurance companies has been more and more disturbing as every claim form contains diagnostic information as well as the date of each session. More importantly, however, is that many insurance companies require the treating psychologist to submit ongoing Outpatient Treatment Reports which are very detailed as to symptoms, coping mechanisms, a case formulation/summary, and response to treatment. Without these reports, insurance companies will not approve payment for future visits, and patients who prefer to “opt out” of allowing the psychologist to share their personal information will not be approved for benefits from their own insurance company. I continue to find these ever-encroaching demands of sharing extremely private information both alarming and a threat to the doctor-patient relationship. As a result, the health insurance company – not the doctor and patient working together – determine the number and type of visits, and whether psychotherapy is available to the patient despite the fact that their policy includes psychotherapeutic treatment.