Whether you're 22 or 92, there's something here for you! I'll be sharing strategies and tips for better management of your mental health and wellness. This blog will offer insights and information about psychotherapy and the systems surrounding mental healthcare. I will touch specifically on clinical topics, such as anxiety, addiction, non-using partners of someone with an addiction, relational/betrayal trauma, life transitions, and developing healthy relationships through boundary setting.
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Check out my first post: Health Insurance and Your Privacy: Is your PHI really private?
Did you know that when you choose to use your health insurance benefits for your psychotherapy sessions you waive the right to any privacy about your mental health with your insurance provider? Did you know that session notes can be audited and reviewed by your insurance company? Did you know that using your health insurance benefits for psychotherapy automatically implies a mental health disorder diagnosis...that follows you even if you change plans, change jobs, change insurances?
Read on to learn how your protected health insurance information is not protected against insurance and how you can access psychotherapy services without using your insurance!
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How private is your protected health information?
Most people want to use their health insurance to cover their medical care. This makes total sense, especially with how much some people are paying for their monthly premium. The idea is this: you schedule an appointment with a medical provider, they assess your ailment, prescribe or offer treatment, and you leave, maybe paying the copay on the way out.
What no one is saying is how any of that information could be used with your insurance company. So let's break it down. Your medical provider is using codes (CPT codes) to properly bill (send a claim to) your insurance carrier (Anthem BCBS, Cigna, Humana etc.) with the expectation that your insurance carrier will cover (pay for) the assessment (physical exam, labs drawn, questions asked etc.) and any treatment they provide or offer (i.e. manual stimulation of left ankle--physical therapy session) at the reimbursement rate (current amount insurance is willing to pay that particular provider for that particular service or treatment) insurance has agreed (via contract with medical provider or practice) to pay, often leaving an amount you (the patient) is required to pay (copay, deductible amount, coinsurance percentage) as well. So how does this affect you? At any point (usually within 12 months of when a service claim is paid out by insurance company) your insurance carrier can conduct an audit with your medical provider or practice which includes viewing assessments completed, progress notes taken, and treatment provided and can determine to redact (take back the money already paid to your provider) if the 1) diagnosis code isn't appropriate (according to insurance) 2) service code isn't appropriate (according to insurance) 3) service/treatment provided is not medically necessary for health or function of the patient (according to insurance) and/or 4) progress note does not state specifically or in the way expected (according to insurance) to capture the assessment, diagnosis, or treatment provided. And! Insurance can conduct an audit at any time, for any patient, for any reason.
How is your privacy affected?
With the process mentioned above to access your insurance benefits (payment for medical services rendered), insurance (or however many people have access to all the health documents your provider is required to send for the audit) companies are viewing all of the information your provider/clinician has documented (because it's required) which for psychotherapy doesn't just include diagnosis (i.e. high blood pressure) and treatment (i.e. prescribed medication to lower BP), psychotherapy progress notes often include sensitive and private processing information from sessions with your therapist (written as vaguely as possible by most therapists because we know how this works).
This brings up two important points about how your privacy is affected. The first is obvious...asking your medical provider to bill your insurance to cover cost for your sessions WILL INCLUDE a mental health diagnosis (hopefully your provider has discussed this with you to some degree) and that diagnosis (like all health diagnoses billed to insurance) will follow you throughout the lifespan. This is important to consider for a few reasons (not an exhaustive list here, just some ideas).
If you have never been in psychotherapy treatment before, never been prescribed psychiatric medications before, and you want to use your insurance for therapy about anxiety symptoms that have newly emerged but have lasted more than 6 months, then your therapist is required to accurately apply a diagnosis that fits with your symptoms to be able to bill your insurance. So if you're interested in managing your anxiety in healthy ways, but don't want a diagnosis to follow you, OPT OUT OF INSURANCE, and opt in to pay your provider privately.
If you have a sensitive position or career (maybe you work in healthcare, maybe you work in politics, maybe you work with kids) and do not want diagnoses to follow you or be public information for insurance, you may want to opt out of insurance to protect your position.
If you need to apply for life insurance, rates and approval are affected by previous diagnoses disorders and illnesses. If this is a concern for you, opt out of insurance for your therapy sessions.
The second way your privacy is affected is by the audit thing I mentioned above. When you agree to use your insurance benefits for psychotherapy, you automatically waive your rights to keeping any of that information shared between you and your therapist private (with your insurance company). They can collect a year's worth (and I've had to actually do this--send a year's worth of progress notes, intake assessment too) of notes and other assessments or measures used to determine "medical necessity" for your psychotherapy treatment. Once your provider securely sends the records to whomever or whatever department is requesting, your provider has no idea who sees your records (although insurance assures us it's only 'the people necessary to conduct the audit' we don't really know whom that is).
This also brings up another aspect of the audit process. Insurance companies (all of them) use outside agencies to conduct their records audits. So this means an entirely other organization, and people, has access to your records. When you think about what kind of things are addressed in psychotherapy (trauma, abuse, neglect, domestic violence, addiction, nuances of your symptoms, relationships with others, work stressors and demands etc.) it's a little frightening that some random folks at some random audit company + your health insurance company and their staff can potentially view things you process in your psychotherapy sessions. And don't get upset at your therapist! They do not have a choice about this if they decide to participate with insurance companies.
What can you do to avoid insurance access to your private health information?
Simply: don't use insurance for psychotherapy! I mean you can, but really consider the implications for yourself, your career etc. before choosing to use your health insurance benefits for your psychotherapy treatment--especially if you've never been in therapy before, have more of a life transition or temporary stressor type of situation, and/or never been prescribed psychiatric medications.
I know what you're going to say: But I can't afford weekly psychotherapy if I don't use my insurance! (And I get it, me too!) What can you do then? How can you access either the care you need/are looking for or the provider you specifically want to work with that doesn't accept your insurance? Here are a few suggestions:
Schedule your sessions every other week to ease the financial burden (*must be clinically appropriate for less frequent sessions).
Join a support group...either for additional support in between scheduled sessions, or in place of weekly or bi-monthly psychotherapy sessions for the issue you're struggling with or with the provider with whom you want to work. Support groups cost less per session than an individual session, and they have the added benefit of including other individuals like you, which fosters connection and post-traumatic growth. *Support groups can often require payment in full for all sessions (closed group format) or could require payment for each individual session you want to attend (collected prior to the group session, this is a drop-in format).
Check to see if your provider (and I do!) offers packages to ease the cost of paying out of pocket for your desired type of treatment or provider. Monthly packages can include various options for sessions/contact with your provider at a discounted rate. *Monthly packages are usually paid for up front, so be sure to plan/budget for this before you get started.
I believe being informed is the best way to be! Well when it comes to you, yourself, and well you, I think it's important to understand some of the systems within which you live and work everyday, and to have as much information that is available to you, to make informed decisions about your choices. I hope my introductory blog grabbed your attention and inspires you to come back and learn more! Thanks for reading :)
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