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  #1  
Old 04-17-18, 01:20 PM
alphalpha alphalpha is offline
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What can psychologists disclose to managed care insurance providers?

Hi all,

Even though my ADHD is mostly in control, I have a lot of side effects, which
over the years, I have been finding are significantly affecting me. So I was
looking into going to a psychotherapist.

Since, psychotherapy is probably going to be a long term committment, I was
thinking of going through my insurance. I have Anthem PPO plan with CDHP.

I have 3 questions regarding this:

1. While searching for providers I came across this quote here:

**Please keep in mind that should you choose to use a Managed Care Plan, your
insurance provider as well as many law enforcement officials will have access
to your information at any time. This may impact your individual privacy.
Therefore, in order to thoroughly protect upmost confidentiality some patients
choose not to use their health insurance coverage.**

If I go through my insurance, does my insurance get access to all the
psychotherapy notes, and patient history?


2. Who can they provide these notes to? Can they provide this history to my
employer or to other insurance providers?


3. I noticed that there are 3 types of psychotherapists in general. 1. Who
accept all types of insurances 2. Who accept a few types and provide a bill 3.
Those who dont take any insurance at all and are a "fee for service"

If you have gone through psychotherapy, has your insurance covered it? Did you
typically have to tell your insurance that you are going for psychotherapy
before hand, i.e. get pre-certification?


My insurance coverage does say that it covers:

*Outpatient Office Visits for the following:
Individual and group mental health evaluation and treatment*

I will ask my insurance provider as well, but I wanted to get some outside
perspective on this.

Thanks you all very much!
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Old 04-17-18, 01:33 PM
peripatetic peripatetic is offline
 
 

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Re: What can psychologists disclose to managed care insurance providers?

hi,

i don't know the full answer or one specific to your insurer, but i do know that for me, my psychiatrist has to link all medications i take to a specific diagnosis. they don't have access to patient notes/clinician assessments apart from 1. diagnosis; 2. medication list.

i have kaiser. my insurance covers therapy through the behavioural health department, but they only cover a standard once a month or twice a month for general therapy. my psychiatrist wrote a referral for me to have weekly (minimum) or twice weekly (his recommendation). groups through kaiser are also covered.

all of these things have a copay, but i see an out-of-plan provider for individual therapy and instead of paying hundreds per visit (i'm in SF so it's expensive here), i only pay $20, which is my copay. insurance knows i'm seeing her, but doesn't get her notes on me.

as for who can be provided those notes...so far as i know you have to sign a waiver to allow another provider, even, to access them. so, for example, my therapist does not have my psychiatrist's notes and vice versa. HIPAA does a pretty solid job of maintaining psych history privacy.

that said, your diagnosis alone IS going to be known, as are any medications you're prescribed. they'll also know how frequently you seek treatment/have appointments.

it's hard for me to imagine this from an adhd only standpoint because i have two other diagnoses, but my inclination is that they would cover it and that's that. one problem with my primary diagnosis (not adhd) is that it alone will disqualify me for supplemental insurance, like supplemental life insurance. the only reason i have any life insurance is that at one time i was gainfully employed and the policy remains as long as i pay the premium each year.

hope that helps!
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  #3  
Old 04-18-18, 10:15 AM
allesandro1 allesandro1 is offline
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Re: What can psychologists disclose to managed care insurance providers?

Your privacy is protected by HIPPA. Be careful of what you sign, but no one would ever share anything with your employer, and not even your physician unless you ask that your physician be informed. He would only ask if he is also your prescriber. Your insurance should cover the psychotherapy but it's on you to find the right provider
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Old 04-18-18, 01:14 PM
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Re: What can psychologists disclose to managed care insurance providers?

The last line of the HIPPA negates all of the aforementioned. Remember that.
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Old 04-18-18, 08:38 PM
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Re: What can psychologists disclose to managed care insurance providers?

No, employers can't get your medical records and definitely not your therapy notes ...

I once avoided using insurance for therapy for fear of word getting to my employers ... And then I got assigned to a different office. One day I'm sitting at my desk and my colleague next to me speaks into the phone to the downtown bosses. "I've got my therapy session at 11. I'll be back later."

Didn't take me long to go public with therapy with my bosses ... I think I used to say, "I got an appointment" and they knew what the heck I meant.

Your employer does fund your insurance ... but can't get into your business ... and doesn't want to ... imagine the lawsuits companies would face if there was evidence they were reading our medical records ... and then promoting/demoting/firing people based on that ...

And trust me: I don't care where you work, you've got colleagues and higher-ups who are going to therapy or have their children in therapy happily using that company insurance.

Go enjoy the heck outta therapy.
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Old 04-24-18, 09:56 AM
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Re: What can psychologists disclose to managed care insurance providers?

Hey all..

Thanks for replying.. I am going to go ahead with therapy..

@peripatetic.. I am also in the bay area.. Psychotherapy/Pyschiatrists are pretty expensive.. but its probably worth it.

I am on CDHP, so will pay most of it upfront till the deductible.. but if I start seeing regularly I will meet the deductible quickly.

@Little Missy, What is the last line of HIPAA?

@ToneTone, yeah.. I actually avoided taking medication for a 3 years since my diagnosis.. and thought I could fight my way through it. I didn't like the label at all.. I have come to accept it these days.. as I see how much different my life can be once I started taking the medications..
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