Using Health Insurance: The Benefits & The Risks

IMPORTANT! Due to the dramatic changes in Healthcare legislation, with who-knows-what's-to-come on the horizon, some clients have expressed concern about risks to their privacy and confidentiality if insurance benefits are used for their counseling. With increased governmental access and multi-company involvement with information revealed in insurance billing, their concerns may be well justified.

Anyone thinking about using insurance benefits should, therefore, read carefully the following statement prepared by our director, Dr. Charles Browning, before making that important and far-reaching decision.

The Benefits of Using Your Health Insurance to Pay for Your Therapy

If you are fortunate enough to have health insurance that covers all or part of therapy or counseling, and we accept that insurance in our office, you certainly can choose to use those benefits here. The most important benefit to you is obvious―you save on the cost of paying for treatment yourself.

At the same time, the long-term risks can outweigh the short-term benefits. Do you know what the potential risks are, and how they can impact you in the future? Most people don't. After you read this, you will be able to make a well-informed choice.

Report and Release of Confidential Information

If a client chooses to use his or her insurance benefits to cover any portion of their counseling with us, the therapist is then obligated to report and release to the insurance company certain personal information shared with their therapist, beyond merely reporting dates of treatment. A "mental disorder" diagnosis must be provided for your insurance to apply. This clinical label then becomes part of your permanent and documented records with the insurance company or with whomever they are required to release that information to. Most clients are not aware of this reality. Let me offer this example: We have had several instances, long after the client has successfully completed therapy, in which the former client has applied for a job requiring a security clearance. The governmental agency responsible for such verification will come into our office and perform an extensive interview with the former client's therapist, asking in-depth questions about all that took place in therapy. In most cases, we are amazed at how much this outside agency already knows about the personal details of the client's life. Add to that what we are required by law to release to the agency ( because the client had to sign a release) and the risk is obvious.

When a child is given a diagnostic label, this can follow him or her into school and college, and even far into the future if they decide to enter the military or other highly-screened employment.

But the information we are required to report goes beyond a clinical mental health diagnostic label. It also includes: situations or personal relationships that affect behavior and thinking, family issues related to the diagnosis, work performance, and specific details about treatment, including the use of medication, if any.

Fortunately, being turned down for benefits when applying for new healthcare insurance plans is far less of a problem these days. But when a client's diagnostic labels and other revealing information becomes part of their permanent medical record, rates can be increased due to that information.

In the past, before all the changes in healthcare, we had much more control over a client's sensitive personal information. We could guard his or her privacy and confidentiality fiercely; and we did so. When the government, insurance companies and their review agencies gain access to those records, we no longer could protect and control our clients' records, and how that information was then used.

Access of Information by Outside Entities

Studies show that the information released on clients using health insurance goes through at least 14 hands when insurance forms are submitted. Insurance companies, as well as their contracted outside review agencies, have recently been requesting additional data on clients. These review companies are requiring not only diagnoses, but extensive personal information about the client as part of their review process to justify coverage.

This means that now a client's personal and sensitive information may be released to more than one outside entity. Additionally, with the upcoming changes to Obamacare ( which exposed clients' medical information to many outside entities), it is possible that even more insurance companies or review groups in other states could gain access to this data, as well.

Avoiding This Risk

There is a way to avoid this potential risk. By keeping all client information only in our office, we can protect and safeguard personal and clinical information from being released. Under the HIPAA laws and regulations, we are able to ensure the client's privacy, from outside sources - including attorneys, courts, employers, life insurance companies or governmental agencies.
As I said, if a client decides to use insurance benefits to cover their counseling sessions, very personal or clinical information is released to outside insurance companies and governmental agencies, and becomes out of our control. Once released, neither the client nor our office can protect this kind of sensitive information, and the safeguards of HIPAA are lost, as well.
This decision to use, or not to use, insurance benefits rests firmly in the hands of each of our clients.

Sometimes Insurance Claims Are Denied

Insurance companies that cover mental health counseling require a certain level of diagnosis in order for the client to be eligible for payment or reimbursement. Some diagnoses will not qualify for this benefit- for example, relationship counseling, marriage and family counseling, parenting counseling, and so on. If diagnoses like these and many others are used, your provider may deny payment.

Can't your therapist modify your diagnosis to make you eligible for insurance reimbursement? It is both unethical and illegal for a therapist to craft the diagnosis for the purpose of assisting a client with insurance eligibility. The therapist must precisely reflect the symptoms or disorder in making the diagnosis with no other factors considered. Most clients are unaware of these important factors.

Your therapist will be able to advise you after one or two sessions if he or she believes that your insurance provider will cover your care here.

Our Commitment To You

With the significant and dramatic changes in healthcare legislation, we believe it is our responsibility and commitment to ethical integrity and practice to make our clients aware of this increased risk and loss of privacy. We certainly do not want the professional help we provide to cause potential future problems for those we serve- we are here to resolve problems, not cause them.

With this in mind, if any client wishes to utilize healthcare insurance, we will be very happy to verify coverage and assist in submitting insurance claim forms with the client's authorization.

It's Your Choice. It's Your Privacy.

What we have provided for you here is intended to bring all things into the light so you can "count the cost" and weigh the benefits and the risks.

Because this information is so important and can have such far reaching implications for you, we suggest that you reread it and then give it much thought before making your final decision on using your health insurance to cover your care with us.

Then, if you have any questions at all, please feel free to discuss them with our front-office staff and with your therapist.

Links & Resources

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