I keep hearing and actually know of friends suffering from different types of mental health problems (typically bipolar, anxiety, depression) who pay cash eventhough they have health insurance or see a primary care physician over a pychiatrist and just get samples on the down-low to avoid insurance paper trails because they say it will be extremely difficult to get future health insurance or life insurance. How much truth is there to this? Is it worth the trouble to try to keep it discrete, doesnt it eventually get exposed anyhow through forums etc... when applying for health insurance? Why would it be so difficult to gain health insurance or have more obstacles when it is just like any other chronic illness like diabetes, heart diseases, cholestoral, etc... Anyone know of or have experience/knowledge of the insurance mumbo jumbo?
I hate to say it, but that's not a bad idea. I've often heard that you should go out-of-town and pay cash to see a psychiatrist/psychologist so that the paper trail won't come back to affect you later.
Well, if your goal is to be able to lie about this in the future without having a paper trail to jam you up, it is illegal.
The current system is focked up. Pre-existing conditions must be disclosed on insurance applications. And I am not so sure you can "hide" your medical treatments - doctors "code" your situation, and a record is kept, and somebody else can fill us in, but there are ways this information is collected by insurance companies (the "Medical Information Bureau" or something like that). Regardless, when you fill out an insurance app, you are required to list a complete history (illnesses, docs, etc) and you are asked to sign a release that allows the insurance company to talk to your doctor, check into your medical background, etc. Falsifying an application is a dumb thing to do - can lead to cancellation or worse, denial of claims. We need to move to a system that insures all comers - not trying to ignite the endless debate on the merits of universal health care, but the current system of private and employment based insurance is stacked against the consumer in favor of the insurance company. People who do not have employment based insurance, but have to go out and try to buy private coverage, are at a HUGE disadvantage - I have read that upwards of 80 percent of people applying for private insurance are denied coverage for pre-existing conditions, or they are offered ridiculously high premiums that effectively are a denial (examples of $3000 a month insurance premiums, for instance). There has to be a better way...but lying about your medical history is not a good idea.
The diagnosis of mental illness and resultant treatment with psychiatric drugs is complicated enough for a psychiatrist, much less a PCP. Many PCPs are willing to tinker around with this, but it is very much outside their training and your mileage therefore may vary significantly. As for problems getting insurance down the road, this won't be true if you are going with employer-sponsored plans as most people do. HIPAA forbids that sort of thing. If your mental health issues are serious enough to be taken to a professional, then they are serious enough to be handled on the up and up. The sort of shame-driven, back alley approach you describe simply won't do. Stand it "like a man".
So then why do so many people pay cash? I mean if you're going to eventually have to reveal the information and it's illegal to hide it, then why do so many try to be discrete and get medicated in all samples when they can get it as a prescription with their health insurance, why do so many people avoid pychiatrists for physicians to solve their mental health issues?
Because in the eyes of the public and many professionals, mental illness carries a huge stigma similar to a criminal record and can lead to discrimination in health and life insurance (not to mention job discrimination). For example, the medical profession is more comfortable with the 200-400 physicians who commit suicide every year rather than tracking the the issue and addressing it formally. It's a pervasive problem that many people are too embarrassed to deal with, in some ways similar to treatable STDs. We want to keep our little secret from the public. If most physicians think that mental illness is something that should be swept under the rug, why wouldn't patients? You should see how physicians treat the mentally ill. It isn't pretty; any semblance of professionalism often goes right out the window. One of our profs told us about a patient who was angry that he was diagnosed with a treatable mental illness instead of a brain tumor... imagine that ... being angry about being diagnosed with a treatable condition instead of a quickly fatal one. That's the reality today.
So how does paying cash conceal it, is it just the paper trail that shows everything. Also how would prospective employers discriminate against you? How will they know?
I really don't have any experience when it comes to "hiding" medical information. I'm not sure I know when and when not to "pay cash." I'm simply pointing out what the stakes might be in certain cases. I doubt that in the usual case medical treatment information would be disclosed and the people you refer to might be a bit paranoid. However, medical information sometimes does get out. I'll give you one example, and I'm sure there are better ones. What it comes down to is that in many professions the small community of people involved (say lawyers who prosecute certain cases or engineers who work on certain kinds of oil production processes) know each other and can check references beyond what the prospective employee might want. Thus, if you get a bad reputation in one place, it might be hard to shake that. Employers do sometimes get involved in their employee's medical care and find out what the employee has, especially if it is something serious. I know someone who had a family member who had cancer. This person's employer is self-insured and also has a special kind of insurance that takes over once the employees bills exceed a certain sum. The insurance that takes over at the high end is questioning some of the medical bills. Needless to say, that person's employer knows about the cancer, mode of treatment, etc. because the employer is involved in the billing dispute (providing information, forwarding requests for information on treatment, etc.). This person doesn't want to lose his job over this by complaining about the rather careless way the medical information is e-mailed around, and so it's a bit of a tough situation. This person wants to keep the job and is much less interested in getting a legal HIPAA settlement down the road. There is also time off needed to transport the family member to care resulting in further disclosure to the employer. I realize that this has nothing to do with mental illness, but you can see how medical information is disclosed sometimes. Once one employer knows about a medical condition, it's possible for that kind of information to stick around. This might apply to an employee who has any kind of chronic illness.
It is illegal to do what you are proposing for the purposes of hiding it from insurers. If elected, Obama has plans to allow purchasing of a federal government plan (similar to what federal employees receive) that would not allow a pre-existing condition exclusion. This is probably the first step to a single payer system, whether that's good or bad. There are options to those with pre-existing conditions who are leaving their employer sponsored plans. Once you exhaust COBRA insurance options, insurers are required to sell you a conversion policy that would cover pre-existing conditions. Of course conversion policies can be just as expensive as COBRA, which is often 3-4 times the cost of regular individual policies.
