What confidential information about you is the therapist required to submit to an insurance company?
Who has access to this information about you?
Can you get access to your own records to see what is being reported about you?
Is the therapist involved in a financial arrangement in which the therapist earns more by seeing you less?
Would your therapist make different treatment recommendations if you were paying directly?
Are there any policies that limit or restrict the treatment that is available to you?
What confidential information about you is the therapist required to submit to an insurance company?
Psychotherapists have codes of ethics that require them to be honest with their clients and to reveal information about how insurance companies are involved in their treatment. Often, a therapist is required to complete a Treatment Report every 4-6 sessions. These reports require descriptions of your diagnosis, symptoms, medications prescribed, degree of impairment, risk of suicide or violence, substance abuse and sometimes details of the ongoing therapeutic work.
In short, these treatment reports demand details of an individual’s life that many would not share with a close friend, much less an insurance reviewer. If you would like to see what a Treatment Report Form might look likehow it asks a therapist to describe youclick here to see a sample Treatment Report.
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Who has access to this information about you?
Once your records are sent to the insurance company, they may become part of their database. And no one can guarantee what will happen with this information 5, 10, or even 20 years from now. Click here for more information
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Can you get access to your own records to see what is being reported about you?
Some clients are reporting that, even after extensive communications with their insurance companies, they have not been able to see their own records. That is, they have no way of knowing how their mental health is being represented in the insurance company’s data banks. Click here for some ways to find out what information is on file for you.
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Is the therapist involved in a financial arrangement in which the therapist earns more by seeing you less?
In some HMO plans, the therapist is paid a certain amount regardless of the number of times you are seen. Under these “capitated” contracts the therapist has no financial incentive to see you after the first meeting. Sometimes s/he receives bonuses for quickly discharging patients.
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Would your therapist make different treatment recommendations if you were paying directly?
Don’t be afraid to ask this question. You have a right to know how your insurance plan might influence your therapy.
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Are there any policies that limit or restrict the treatment that is available to you?
Ask what the appeals procedure is if you are denied treatment or find it unsatisfactory.
If the answers to your questions are not satisfactory, you have a right to a second opinion. Good therapists will be open and honest about the involvement of the insurance company in your treatment. You have a right to know about alternative types of treatment and limits set by your insurance policy.
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