I am “In Network” and a “Participating Provider” for the following insurance plans:
- BlueCross BlueShield
- First Choice Health Network PPO
- Providence Health Plan
Since insurance plans and their networks change frequently, I always encourage new patients to call the number on the back of your health insurance card to verify coverage before receiving treatment. This also allows you to know how much your deductible is (if any), copay amount, and if a pre-authorization for behavioral health treatment is needed.
You can request to be seen as a private pay patient. There are several advantages to being seen as a private pay patient, including increased confidentiality and not needing a mental health diagnosis. I offer a reduced rate for private pay patients when paid at the time of your appointment. I do this for two reasons: To make services more accessible and available. There’s an important third reason, actually: What we talk about is confidential and the details of your mental health issues shouldn’t be available to anyone else, including your insurance company.
The Truth about Confidentiality
Talking with a therapist is a very personal and private event. Counselors strive very hard to keep what is said in session confidential. Unless required by law, your private information is not released without your permission.
Except it doesn’t really work that way…
The reality is that what you talk about with your therapist ends up getting bought and sold, usually without your consent or knowledge. Worse yet, the cumulative data collected in this way ends up being available to marketers, advertisers and researchers, but not you. Some of this is done for honest and worthy reasons, such as helping researchers understand and improve mental health disorders. Some of the information is used to help pharmaceutical companies develop more effective marketing strategies. And unfortunately, some of the data will be used for reasons we don’t know, a type of underground information black market; mostly because no one is talking about what is done and we have no legal rights to request this information. This intrinsic dance for the possession of your intimate information happens behind the scenes every day without your knowledge.
How Insurance Can Backfire
Consider what happens if you’re seeing a therapist for problems with depression or anxiety. Since insurance companies won’t cover the costs involved with anything not deemed “medically necessary”, chances are you’ll be assigned a diagnosis indicating the presence of a bona fide mental health disorder. The difference is profound: You may be feeling a little sad, but now your permanent medical record reflects a hard-core diagnosis of Persistent Depressive Disorder, for example.
From your point of view, you’ve only seen your therapist. But in order to have your counseling session covered by insurance, the counselor enters your details into a third-party billing system, which delivers the data to a medical claims clearinghouse. This organization acts as a claims processor, contacting your insurance company to confirm your coverage, co-pay amount and deductible and to arrange for payment to the therapist.
But both the clearinghouse and your insurance company have now learned that you are severely depressed, sexually impotent, have trouble concentrating on things and suffer from uncontrollable panic attacks. The company that processes your therapist’s billing, has found out as well. If your information is sold off to an outside buyer, it will be anonymized by removing your name and other critical information, but information such as your gender, partial zip code, year of birth and therapist’s name will still be there.
What’s Really Going On?
How these companies make use of their records on your mental health disorder is something they keep secret. Many routinely sell this data to commercial data collection companies (“aggregators”). If you ask, they will either decline to comment or give you a boilerplate generic answer such as, “We do not sell any information as we value our customers’ privacy” which is both vague and as suspicious-sounding as, “Your call is important to us, please continue to hold.” The bottom line: Information is the new currency, and most companies do indeed sell anonymized information to data aggregators.
Not Really Anonymous Anymore
How anonymous is your information? Most people have heard about HIPAA (Health Insurance Portability and Accountability Act) in regards to patient privacy. And to be fair, it is protecting you to a certain degree: Your information cannot be shared without your consent if your name is included. The dilemma is that once your name is removed, your consent is no longer needed. And from this anonymous information, very specific patterns that identify you can be formed. In today’s day and age, your name is no longer as uniquely identifying of who you are as is your details. Reverse-engineering and cross-referencing anonymous data in research studies have shown that privacy is, at best, an illusion. As anonymous patient data grows more extensive, it is indeed likely to figure out who is who.
Theft of Your Information
Theft of your personal information by hackers is another real concern. So far, we’ve been lucky (or simply misinformed). In the past five years, more than 41 million people have been affected by illegal U.S. health record theft and hacking attempts. In early 2015, Anthem Health revealed that much of its patient data on nearly 80 million people was compromised… back in 2014. If your financial information is hacked, you can change your passwords and have the protection offered by FDIC insured banks; there is no equivalent protection offered for restoring your privacy.
Perhaps the practice of anonymizing and sharing patient data is ultimately helpful. The big questions that we deserve answers to are howis our private information being anonymized, who is buying and selling our information, and what protections are being given to us to prevent the theft or sale of our data? Until we are given a vote in the matter, we really are out of the loop.
First, if you need to see a therapist or counselor, you should still go. If your marriage is falling apart, depression is wrecking your life or anxiety is ruining your career, concerns about privacy should not be placed above your health and well being. Period.
Ask your therapist about the option for private pay. When you mention that you’re interested in paying out-of-pocket for privacy concerns and would rather not use your insurance, most therapists will respond rather positively. In fact, many have discounted rates for private pay when performed at the time of service. It’s less paperwork for them and enhanced privacy for you; a lower charge for each session should reflect this reality.
Consider asking your therapist to anonymize your data. Since you’re private pay, no insurance billing is necessary so the storage of personal details can be kept to a minimum. Ask your therapist to store your session notes under an ID number and to separate your session’s progress notes (clinical details) from your psychotherapy notes (personal details). Psychotherapy notes, when stored in this manner, are considered much more secure and access is additionally restricted under current laws.
It may be worth asking your therapist to keep notes on your session in a non-electronic format (i.e., paper and pen). Again, since you’re paying for your sessions privately, this gives you some degree of bargaining power. And what isn’t stored electronically can’t be hacked.
To sum it all up, when we put our trust and faith in the mechanisms of privacy, we’re essentially playing with a loaded deck. Better to control the odds and play with a few aces up our sleeve. After all, the goal is to get help and to get it effectively. Privacy-minded approaches are always welcome, and strongly encouraged.