In recent years, medical insurance companies have undermined the confidentiality of psychotherapy by requiring psychotherapists to submit information about their patients. People who use their medical insurance or disability insurance to pay for psychotherapy waive some of their rights to confidentiality. If you use your insurance, a psychiatric diagnosis must be assigned and transmitted to your insurance company, detailed clinical information often must be provided by your therapist, and in the case of “in-network benefits,” total access to patient files often must be provided to insurance company employees. For example, one managed care contract states "Upon reasonable notice...[insurance company], its authorized representatives, and duly authorized third parties... shall have the right to inspect and/or be given copies of medical [including psychotherapy] records directly related to services rendered to Members by Practitioner."
Further, insurance companies often attempt to influence the methods or course of treatment so as to save money. That means treatment decisions are taken away from you and your therapist, the two people in the best position to make such decisions. Finally, psychiatric diagnoses may affect your ability to obtain future health, life, or disability insurance, or to obtain it at a reasonable cost. (Click to go to the Health Privacy Project for more information.)
There is no way for me to ensure that your confidential information will be treated as private if it is transmitted to an insurance company. For example, employers sometimes are able to obtain personal information from insurance records.
New banking laws also may allow insurance companies to share information with their affiliate companies unless you opt out. Because private health information is moving to computer and internet-based systems, it is becoming even harder to control access once this information is in “the system.”
Whereas medical privacy may be a major concern for some people, psychotherapeutic effectiveness depends completely on trust and confidentiality. In order to protect my patients’ confidentiality, to provide ethical treatment, and to reduce administrative costs, I encourage you to pay out-of-pocket for your psychotherapy. I am happy to provide you with a simple billing statement that you may submit for “out-of-network” insurance reimbursement and/or for tax purposes.
On the other hand, in the unusual circumstance of your insurance company asking for extensive diagnostic information, detailed treatment information, or a treatment report in order to authorize reimbursement to you for therapy, I may use my professional discretion in not providing that information. In that case, your insurance company may refuse to reimburse you, and you will be responsible for the entire cost of treatment.
For those in especially sensitive occupations or positions: If you choose to pay by Visa or Mastercard, your credit card statement will indicate that you received services from “Jason A. Seidel, Psy.D. P.C.” which may be coded by your card issuer as services from a “medical health provider.”
From time to time, I may mail to you a statement or bill for services. The return address will indicate my degree as a psychologist (“Psy.D.”). I may call you at phone numbers you have given me (for example, to discuss scheduling). I may leave a message with my name (“Jason Seidel”, not “doctor”) and phone number.
If your situation requires absolute confidentiality, please indicate to me your specific concerns about such communication. Other special arrangements may be made, on a case-by-case basis.