THE ETHICS OF CONFIDENTIALITY ~~ Why I Don't Accept Insurance

UPDATE ~ MAY 17, 2010

An article in the Boston Globe this past week illustrates one of the various reasons why I've taken the stance I have by not accepting Insurance.  The article includes examples from various therapists across the nation related to preauthorization, and being subjected to, "Lengthy telephone reviews regarding a patient's need for continued treatment after every 10 sessions --  denying many client's access to the therapy that has helped them function and return to work, some after lengthy depressions."  
"We are seeing what seem to be excessive preauthorizations and other reviews that we don't see for other medical services,"  said Matt Selig, executive director of Health Law Advocates, a public interest law firm based in Boston.  He was addressing the existence of the Mental Health Parity Act.

"Selig said his organization is compiling examples to determine whether to file a legal challenge on behalf of some patients and therapists."  "United Behavioral Health, a California based insurer, is the nation's largest, providing mental health services."  The article continues, ".....Therapist's say they are being forced to spend numerous hours fighting with United Behavioral Health reviewers over the phone, advocating for care their patient's need."

     
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 Protecting  your identity is of the utmost importance to me ~ Insurance Co.'s require the threapist/clinician to fill out forms after approximately 5 sessions, and provide information about the client's status, i.e., improvement on goals set for therapy.  These forms require the therapist (clinician used interchangably) to provide detailed, and often very private information about what you disclose in the process of your treatment/healing venture.  Issues realted to substance abuse; mood disorders, medications prescribed by psychiatrist's or other healthcare provider's, issues related to previous or current abuse, etc. are all private matters.  I am concerned this information is not held private once it reaches the beauracracy of the billion dollar Insurance industry. 

It is your business, and your's alone when it comes to what you want to disclose about yourself and to whom, and when.  My professional ethics and moral principles are such I do not wish for your personal sense of well-being, trust and sense of safety to be jeopardized. 

One last note.  You may want to speak with your Insurance Company about reimbursement.  My policy is to be paid at the time of each visit.  I will provide you with a receipt, which you can send to your Insurance Co. to inquire whether you are eligable to be reimbursed a portion of your total fee.  My receipt can also be used as a tax deduction (ask your CPA before you file your income taxes).  

Insurance Co.'s are interested in the quickest resolution possible, and often will not provide access for therapeutic services after a set number of sessions.  I am concerned about the continuity of your care, as I don't believe a trusting relationship can be obtained with a therapist/clinician without on-going contact and processing of the presenting problems the client wishes to work on in order to improve their quality of life.  A safe/secure/consistent environment is the basis of a positive working alliance between client and therapist, and Insurance Co.'s often distract from focusing on the goal of treatment, and often create a distraction since client's don't trust their personal information will be kept safe within the confines of the therapeutic space/office setting.  This is the primary reason I do not accept Insurance and offer a sliding scale.  It also affords me the opportunity to focus completely on my client's without any outside distractions.

Warm Regards,
Sarah~