View Full Version : Paranoid about insurance and records

05-09-04, 06:04 PM
What do y'all think about this?
Comments on using insurance for psychotherapy.

About using any type of insurance. When you use insurance for psychotherapy, you are “on record,” so to speak, as having been in psychotherapy. There is reason to be paranoid about what information gets into the system. At the least, the fact that you sought psychotherapy will be in the system. I have not heard (so far) of that fact alone affecting your situation, unless you run for president. However, if a therapist diagnoses you on the insurance form with a depressive or anxiety disorder, for example, that could affect your ability to get insurance or the risk category to which you are assigned. (To minimize your exposure, I routinely diagnose everyone with the mildest diagnosis in the book: “adjustment disorder with mixed anxiety and depressed mood.”) If your M.D. prescribes Prozac and puts that in his or her records and/or if you pay for it with insurance, then your insurance situation will definitely be affected. You should weigh these considerations before deciding to use your insurance to pay for psychotherapy or medication.

About HMO’s. Nearly all those I know who tried get therapeutic help through their HMO were dissatisfied. They couldn’t find the right therapist, their complaint was not serious enough to qualify, they did not get the number of sessions they needed, or they were worried about the all the confidential information that the therapist had to communicate to the insurance company in order to get paid. (The confidentiality concern is much more serious with an HMO than with other forms of insurance because your therapist must describe and diagnose your condition as serious enough to justify treatment, and he or she must frequently describe your progress.) As a practitioner, I feel that working for an HMO puts me in a conflict of interest in two ways: (1) if I don’t fight for the number of sessions that my client actually needs, he or she won’t get adequate treatment; and if I do fight for my client, I will be dumped from the panel and get no more referrals. (2) If I minimize the seriousness of my client’s situation, he or she may not receive authorization for treatment; and if I make the evaluation serious enough to be authorized, the diagnosis will be in your records and could hurt you later. (3) If I do an honest job for the insurance company when I write evaluations and progress reports, I may hurt my client when he or she applies for an insurance policy or a position. Having a conflict of interest is in violation of the code of ethics for psychologists. Besides the conflict of interest issue, there is a self-interest issue for me; I can’t afford to work with HMO’s. They require a lot of time for paper-work in return for the very low fees.

05-09-04, 06:56 PM
I believe you have to call it like you see it and use the correct diagnosis. I hate managed care and the paperwork nightmare that it creates for me as a practitoner.Jumping thru their hoops is a hassle as well.When it comes to the diagnosis tho, you have to make the correct call. I do agree that adjustment disorders are the least intrusive; as long as they are also the correct dx.By the same token, you cant be afraid to use a V code either, if thats the right call as well;knowing that you wont get paid for it at the same time.

The bottom line is that the practitoner is always walking a fine line between practice efficacy( using research/science based techniques) and ethical practice (following the Rules of Conduct for your states licensing board + the APA Ethical Principles)'

This is an interesting article and I appreciate your having posted it.
Thanks again.


05-09-04, 06:59 PM
The article itself kind of looks like a commercial to

05-12-04, 12:17 PM
Just my $0.02 - I don't think the article sounds commercial at all. Perhaps b/c I've been trained to work in fields that utilize mental acuity, where any condition that calls that into question can jeopardize your employability (especially in this market where every corporation I know is looking to slash costs wherever possible and lays employees off regularly with impunity), I choose pretty regularly to pay for mental therapeutic care out of pocket and look for nutritional, rather than pharmacological, assistance for mental health conditions, more often than not.