Invasion of "Personal and Confidential" Information?

Vijai P. Sharma, Ph.D

Patient information, once considered a sacred part of any doctor-patient relationship, is all over the place in the present managed care environment. Patients have no idea how many people are pouring over their so-called personal and confidential information.

If you think that the invasion of privacy is limited to mental health services only, think again. Confidentiality laws do not even mention pharmacy records. In order to process claims, your pharmacist sends information to either an information processing company or, directly to your managed care company. Information including your name, address, medication, and doctor’s name is routinely being sold to other companies.

When you apply to an insurance company for health or life coverage, your entire personal and medical profile, including your psychiatric diagnoses is sent to the Medical Information Bureau where it is made available to thousands of insurance industy representatives. Once a diagnosis is entered in your record, it stays.

Too many administrative people have gotten involved in the healthcare business who in no way directly contribute to your treatment. Their job is to process and review information concerning you. Over 50% of mental health funds are now consumed by administrative costs. Managed care companies employ a vast clerical and administrative staff to closely review your personal and treatment information to determine how much and what type of services you should receive. The intrusion into private and sensitive information has dramatically escalated in the recent years.

Consumers need to be more alert and knowledgeable about their rights and the ways in which managed care companies administer their contracts. Unfortunately, many people who are under managed care don’t even know it. They ask, "How do I know I have managed care?" Well, if you say "yes" to any one of the following four, you are under a managed care health plan:

  1. Are you required to be treated through an HMO?
  2. Is your choice of who you can go to limited to a specified list of professionals? Would it cost you more if you go to someone outside that list?
  3. Are you required to get authorization from your insurance or your primary care physician before you receive treatment?
  4. Is your treatment evaluated for "medical necessity?"

If you answered "yes" to any of the four, you should identify the people who are involved in taking decisions about your treatment and the information they will share about you among themselves. Bear in mind that they want to know a lot of things about you to determine how "severe" your problem is and whether the treatment at this point is "medically necessary." Patients and professionals are made to provide personal and sensitive information in order to get the permission for treatment.

One way that you can have 100% control over your treatment and personal information is by paying cash for your treatment. This is not a practical solution for medical treatment but it may be a viable option for many people who only need individual or family counseling. If medication is not required, total counseling fees, on average, fall within a thousand-dollar bracket. If you want to file for insurance, take a more active and alert role in monitoring the personal information and making sure that you get adequate treatment to meet your needs.

When you ask your insurance or managed care company for authorization for mental health treatment, start a phone-log right away. In this log, write down the first and last name of the person you talk with, telephone and extension number, date and time of your call and the specific information regarding what that person promises to do. These notes will help you if you later encounter difficulties. Ask for information regarding the following: What the company will pay and what you are expected to pay from your pocket; number of sessions authorized and if there are any diagnosis or situations which are not covered by your plan.

If your request is denied or reduced, appeal it. You have more power and a better chance of success if you conduct your own appeal rather than relying solely on the appeal by your healthcare professional. Request copies of all exchanges between your insurance and the healthcare professionals.

According to a mental health consumer protection manual, those who complain loudly and bring problems to the attention of the higher-ups generally get the problem resolved in their favor.


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Copyright 1996, Mind Publications 


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