Insurance vs. private pay and "off the record" counseling

[Bubba3]

This may be an inappropriate question to ask - I apologize in advance. But it's been on my mind and I know SDN from the medical side so I thought I'd ask to see if anyone over here can give me an answer.

My husband is considering starting a CBT course with a PsyD, and he is trying to decide if he should use our insurance. People in the past have told me in their own therapies that they paid out of pocket to avoid having a diagnosis "on their record" because having a DSM-IV diagnosis could haunt them with life insurance, security clearances, loans, etc.

What I'm confused about is exactly what this "record" is. Is the record just someone's file at the insurance agency? As far as I know, there is no such a thing as a "permanent health record" that follows the patient from provider to provider, at least in the US. How would a creditor or government agency ever get access to a "health record" anyway? If it's all through the insurance trail, does that mean that paying out of pocket keeps treatment notes and any associated diagnosis "off the record" unless the patient explicitly consents to have his records from the psychologist's office released?

Thanks in advance. Apologies again if this is an inappropriate question. 🙂

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[erg923]

This may be an inappropriate question to ask - I apologize in advance. But it's been on my mind and I know SDN from the medical side so I thought I'd ask to see if anyone over here can give me an answer.

My husband is considering starting a CBT course with a PsyD, and he is trying to decide if he should use our insurance. People in the past have told me in their own therapies that they paid out of pocket to avoid having a diagnosis "on their record" because having a DSM-IV diagnosis could haunt them with life insurance, security clearances, loans, etc.

What I'm confused about is exactly what this "record" is. Is the record just someone's file at the insurance agency? As far as I know, there is no such a thing as a "permanent health record" that follows the patient from provider to provider, at least in the US. How would a creditor or government agency ever get access to a "health record" anyway? If it's all through the insurance trail, does that mean that paying out of pocket keeps treatment notes and any associated diagnosis "off the record" unless the patient explicitly consents to have his records from the psychologist's office released?

Thanks in advance. Apologies again if this is an inappropriate question. 🙂

I think the concern may be a bit exaggerated, but yes, certainly stuff can follow you. If you have an insurance plan, you can bet they have your health history. How do you think they determine individual rates, preexisting conditions, etc.?

 

[Pragma]

It has been awhile since I looked into it and not sure what the ACA has done to impact things, but I think there is some kind of central database that insurance companies use. Maybe I am getting it mixed up with other types of insurance.

 

[JeyRo]

This may be an inappropriate question to ask - I apologize in advance. But it's been on my mind and I know SDN from the medical side so I thought I'd ask to see if anyone over here can give me an answer.

My husband is considering starting a CBT course with a PsyD, and he is trying to decide if he should use our insurance. People in the past have told me in their own therapies that they paid out of pocket to avoid having a diagnosis "on their record" because having a DSM-IV diagnosis could haunt them with life insurance, security clearances, loans, etc.

What I'm confused about is exactly what this "record" is. Is the record just someone's file at the insurance agency? As far as I know, there is no such a thing as a "permanent health record" that follows the patient from provider to provider, at least in the US. How would a creditor or government agency ever get access to a "health record" anyway? If it's all through the insurance trail, does that mean that paying out of pocket keeps treatment notes and any associated diagnosis "off the record" unless the patient explicitly consents to have his records from the psychologist's office released?

Thanks in advance. Apologies again if this is an inappropriate question. 🙂

There are no solid guarantees of privacy today, period. I've private paid for therapy myself, for the very same reason.

 

[Pragma]

Did a google search and my understanding is that records from the past 7 years can be shared among insurance agencies. Looks like the central source is called MIB.

http://www.medicalrecords.com/consumers/what-is-the-mib-medical-information-bureau

 

[HomeworkHelper]

I do wonder if it makes much sense to worry about something like this in most cases, particularly if the issue someone is seeking help for is something relatively common, like depression or an anxiety disorder. I don't think the concerns would outweigh the financial benefit of going through insurance. If it were something that entailed a more chronic/severe course, like bipolar/schizophrenia/borderline PD, then I may have more concerns and take the time to research more about the potential harm of having that diagnosis available to insurance companies. However, in those cases the longer-term nature of care may necessitate going through insurance anyway.

 

[Bubba3]

There are no solid guarantees of privacy today, period. I've private paid for therapy myself, for the very same reason.

Thanks for the responses everybody. It seems like the MIB is indeed the source of this "record" I keep hearing allusions to.

Am I correct to assume that paying with cash avoids the MIB and "health record" altogether? So anyone who can pay out of pocket has the luxury of keeping their treatment completely private. That isn't really fair, huh? 🙄

We'll have to weigh the pros and cons of a diagnosis on the record for considering whether to use insurance. We have a relatively high copay and deductible anyway, and his preferred provider is out of network. So cash might end up being the best option anyway, if the "match" to a therapist is the most important factor.

 

[psychRA]

Am I correct to assume that paying with cash avoids the MIB and "health record" altogether? So anyone who can pay out of pocket has the luxury of keeping their treatment completely private. That isn't really fair, huh? 🙄

This is my understanding as well. If you go through insurance, your therapist has communicate a diagnosis (at the very least) to your insurance company in order to justify their services. If you pay cash, ethical standards still require your therapist to document the services, but nothing needs to be communicated to any outside organization, and no one knows that you received services unless you tell choose to tell them.

I do think it's unfair that people who can't pay out of pocket don't have the option to keep their services more private. There are situations where it does make sense to worry about having a record of your treatment, FYI. If you work in some government sectors (e.g. defense), getting mental health treatment can be an impediment to higher security clearance. I have an immediate family member who refuses to seek counseling specifically because of their security clearance 😡

I'm not even in a clearance situation, and just to work at the VA, I've had to fill out detailed questionnaires about my physical and mental health treatment history every time I took a job. I find it pretty invasive, but there doesn't seem to be any way around it.

 

[bmedclinic]

I have an immediate family member who refuses to seek counseling specifically because of their security clearance 😡

Ditto. Have a relative with a pretty high security clearance because of their specific occupation. Their need is within one of my preferred subspeciality(think behavioral medicine), but them ever going to see anyone about it would probably make them lose their job. It's not anything serious, but they wont even talk to me about MH in general... that's the culture for their position.

 

[Bayside]

In addition to the above, having a mental health or substance abuse diagnosis can also effect your ability to get certain types of insurance (and/or the rates you may be offered). If you claim through your health insurance for MH services a diagnosis will be used in almost all cases ( v codes are rarely reimbursable) and some payers require fairly invasive info from providers before agreeing to pay for services. Providers have little choice but to provide this info if they want to get paid but cannot control what happens to the info once into the hands of the insurance company. (Read the small print on the disclosure statement you will be asked to sign). So, if confidentiality is a concern (and why wouldn't it be) I would strongly recommend talking to the service provider about who will have access to the record and under what circumstances and how this will differ under a cash for services arrangement .

 

[JeyRo]

Thanks for the responses everybody. It seems like the MIB is indeed the source of this "record" I keep hearing allusions to.

Am I correct to assume that paying with cash avoids the MIB and "health record" altogether? So anyone who can pay out of pocket has the luxury of keeping their treatment completely private. That isn't really fair, huh? 🙄

We'll have to weigh the pros and cons of a diagnosis on the record for considering whether to use insurance. We have a relatively high copay and deductible anyway, and his preferred provider is out of network. So cash might end up being the best option anyway, if the "match" to a therapist is the most important factor.

Nothing is ever completely private. If the therapist works with medicare patients, they may get their charts audited at some point (e.g., re. a fraud investigation perhaps). But private pay does drastically increase the chances no eyes other than the therapist will see the notes or any records that services have been sought and received.