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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Dinah on August 30, 2003, at 17:11:40
I may be looking for a new pdoc, and my therapist has mentioned that he is newly listed under some insurance plans. I may ask him about mine.
But honestly the idea scares me senseless. I've already gotten a nice little letter from my insurance company saying that "We have noted from your claims that you have been diagnosed with diabetes. We would like to tell you about all the services we offer to diabetics." Frankly, that bothers me no end. I don't like some perfect strangers knowing about my insides, and worse yet having the unmitigated gall to contact me unasked to comment on it.
I can just imagine the letter now about my mental health. Eeeek.
Precertification is required under my plan for mental health coverage, and the plan contracts to an outside party to handle mental health coverage. I went to this outside party's website and looked up the practioner guidelines. It requires not only a diagnosis code, but a GAF score, a treatment plan, specific and identifiable treatment goals, etc.
And I've heard elsewhere that insurance companies have access to about all of your mental health records except maybe the notes. But what exactly that entails, I'm not sure. How about things I write to him? How about things other mental health professionals write to him. Like my personality test results.
If I start using my insurance in a pre-certified fashion for mental health coverage, how much privacy am I signing away? Will they know about my dysfunctional behaviors? Will they be telling my therapist how to effectively treat me? How about more sessions than they will cover. Can I continue to pay for that out of pocket?
I just don't like the idea, but I suspect that now I've mentioned it to my husband he'll want to follow through. Right now my records are between me and my treatment team. I want to keep it that way!
Posted by fallsfall on August 31, 2003, at 15:03:35
In reply to Insurance and privacy, posted by Dinah on August 30, 2003, at 17:11:40
Dinah,
My old therapist told me that the insurance company could request my whole chart, but that she would send to them as little as she could get away with.
My understanding of Hippa (and this could be totally wrong...) is that there are two sections to the charts - one with the daily summary that the therapist writes, and the other with things such as the journaling that I used to give her. She read some of the summaries to me. I found them a little dry and factual (probably a good thing). So if she had to send those in, at least I felt comfortable that they were accurate. I believe that she just filled in a 1 page (2??) for the insurance company. Sometimes she showed them to me. I believe she showed me the one for SSDI.
A friend has the joy of filling out the insurance form with her therapist every time it is needed. I think that this gives them an opportunity to talk about status and progress and what needs to be done (she's not likely to talk about that unless forced).
Have you seen stuff that your therapist has written up? He must do insurance things for other patients, can you ask him what kinds of things would be included? What would he consider to be a treatment plan and goals? I was always amazed at how vague she could be and get away with it. I haven't seen anything from my new guy. She used to bring the chart with her so she could look back at things during the session. I've never even seen a chart at his office.
I have NEVER had an insurance company contact me and refer to a diagnosis. I agree that is really out of line.
>>If I start using my insurance in a pre-certified fashion for mental health coverage, how much privacy am I signing away? Will they know about my dysfunctional behaviors? Will they be telling my therapist how to effectively treat me? How about more sessions than they will cover. Can I continue to pay for that out of pocket?
Again, ask your therapist what he would include. I think that a treatment goal might be to reduce self-injury. But that nowhere would it say what kind of self-injury you do. A goal might be to increase socialization, but it wouldn't say that you hide in your garage whenever visitors come to the house (I don't know what you do or why... you will have to fill in the blanks).
My understanding is that they will not tell your therapist how to treat you. However, they will say that they will only pay for X sessions in Y weeks. For people who can't pay for therapy this in essence does tell the therapist how to treat a patient.
The insurance company doesn't care if you want to pay for extra sessions. I would think that they wouldn't even know that you are doing that - wouldn't your therapist only bill them for the sessions that they have agreed to pay for?
Ask your therapist. He can tell you what kinds of things he needs to include and what he doesn't.
I don't like the idea of the insurance company having so much information on me, but I like the idea of giving up therapy less.
Please remember that everything I wrote here is my somewhat informed opinion filtered by my brain which doesn't work at all.
8^)
Posted by fallsfall on August 31, 2003, at 22:15:40
In reply to Insurance and privacy, posted by Dinah on August 30, 2003, at 17:11:40
Was reading some old posts and found this. I haven't looked at the articles, but they might help you (as might the thread)
Posted by Dinah on September 1, 2003, at 6:36:41
In reply to Re: Insurance and privacy » Dinah, posted by fallsfall on August 31, 2003, at 22:15:40
I appreciate it. It's a hard decision, because in some ways I it would add a lot of untherapeutic stress to the situation.
I'm going to ask him tomorrow. If he's not on my plan, I'm worrying for nothing.
Posted by Dinah on September 2, 2003, at 10:27:08
In reply to Insurance and privacy, posted by Dinah on August 30, 2003, at 17:11:40
Posted by Penny on September 2, 2003, at 10:49:47
In reply to I wonder if I'll have the guts to discuss it today (nm), posted by Dinah on September 2, 2003, at 10:27:08
If it's the right time for you to discuss it, I have confidence that you will find the encouragement you need to discuss it.
I have decided that I can no longer worry about what the insurance companies know about me and my issues. If I knew the person who was handling my case personally and I had to face that person on a frequent basis, *then* I might care. But that person only knows me as a name and number on a piece of paper, among many other names and numbers. Chances are the person who is reviewing your case doesn't really care what he or she is reading, etc., but is just going by some designated formula to decide which claims and treatments to cover and which to deny.
Of course, maybe if they did know you as a person and not a name and number, there wouldn't even be the question of whether or not to certify extended visits, etc.
Talk to your T and see if he's willing to fight for what you need. If there's fighting to be done - both to keep as much of your personal info private and to get the treatment you need covered - you need him on your side in a strong way.
I would imagine, though, that sharing info such as the things you write to him, etc., wouldn't be pertinent to the matter at hand, and therefore isn't shared.
P
Posted by Susan J on September 3, 2003, at 13:00:40
In reply to Insurance and privacy, posted by Dinah on August 30, 2003, at 17:11:40
Hi,
I think HIPAA's new privacy laws, which went into effect this year, keep all of your medical records private, including their electronic transmission for claims data. Yes, your insurance company will know you are receiving mental health treatment, but I think now you need to sign a waiver releasing any records to anyone.
I can look it up for certain when I get back to work next Monday.
I work for a government agency, and used to work in the HR department with health claims data. All my old coworkers, if they wanted, could look me up and see I'm receiving mental health treatment. Not a big thrill for me, thinking they are laughing and snickering at me, but the good of the therapy outweighs the bad of the lack of privacy...
Good luck with all,
Susan
Posted by Dinah on September 3, 2003, at 14:13:34
In reply to Guys, Don't Quote Me, But.... » Dinah, posted by Susan J on September 3, 2003, at 13:00:40
Thanks Susan, but at this time, I think I'll let it go. I think it would not be good for me therapeutically to get a third party involved in my therapy. I'm just too paranoid and sensitive, I suppose. The whole idea of treatment plans and stuff just makes me darn uncomfortable.
It was good though to think about it in case I ever absolutely can't get therapy without it.
I'm not even going to ask about it.
This is the end of the thread.
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