Archive for the ‘cpt code’ Category

You, Your Insurance and Privacy of Our Work, Pt III

Wednesday, October 13th, 2010

OK, now for the kicker. The something more. This information that lives with your insurer and their insurers isn’t finished yet. What happens if you apply for life insurance? An auto loan? Change jobs and need to sign up for other health insurance? Apply for a credit card? Have you guessed yet?

That’s right. These worthies will often turn to an agency that they hire to collect your information, your protected health information, and that agency will then turn to me and request the records of your treatment. They will sometimes accept a summary but I have to tell them that’s what they’re going to get. What you’ve signed, after you first told them that you had this treatment (if they ask, and for life insurance they sure will,) is a consent for release of information for your medical records. That means they are going to be requesting my session notes (which are part of your official medical record.) This also means that this 4th party outside of the triangle of you, me & your insurance company (and their backers, but I included them in the triangle – so what if it’s got 4 sides? I’m a psychotherapist not a geometer) has your protected health information in its data bank. Yes, the release you signed is HIPAA compliant. They know the law & know that that’s what they have to give you. It doesn’t mean that they are as careful about disclosures as your psychotherapist (me, in this case.)

Does this chill you a bit? If it doesn’t then you’re not following the flow of your information. Wider and wider circles of dissemination.

Now, I’m not saying that if you and I keep things between us and you leave your insurance out of our relationship that you won’t at some point decide that you want life insurance and they won’t ask about treatments you’ve received. If you do they will. I won’t tell you not to tell them about treatments. That would be telling you to commit fraud and I won’t do that. I won’t tell you to lie on the application. I will tell you that, unless you are asked about treatments, in most cases (within the limits of the laws about confidentiality) it stays between you and me (maybe your accountant and Uncle Sugar if you claim it on your taxes, but I’m not going to go there.) There are limits imposed on confidentiality by law, such as if I think you are an immediate danger of committing harm to yourself or somebody else, or in case of suspected cases of child abuse but within the law what’s between you and me stays between you and me. Personally, I like it that way.

Another time I’ll tell you why I don’t like “diagnosis” as used in the DSM (or ICD,) but that’s not part of this. Let’s call it a day and I’ll go back to enjoying my cup of tea.

You, Your Insurance And Privacy of Our Work Together

Wednesday, October 13th, 2010

“Do you take insurance?” Yeah. I’m in-network (“par,” in insurance terms – participating) with several plans and take assignment. I’m not in-network (“non-par” – I don’t par…never mind. You get the idea) with many more than I’m in with. There’s various reasons for that, none of which really matter here. Feel free to email me if you really need to know but, trust me, that’ not what this is about.

Personally, I’d rather you not use your insurance. That way we can keep things just between us (the two of us, not the two of us and a lot of other people.) I know that you want to have your insurance company pay me (“par”) for part of your treatment or reimburse you (“non-par”) for some of what you paid me. It makes absolute cents. Dollars and cents. Unless you work for the exceedingly rare, and growing rarer all the time, companies that pay your entire premium, you pay a lot for your share of the premium on your health insurance. You want to get something for that hard earned cash that’s not going into your paycheck. Even if your policy doesn’t cover “behavioral health,” you may have a flex or cafeteria plan that you can use to cover some of the period of treatment, some sessions, something.

I get it. I feel the same way about my health insurance. I want to get something back for the money that’s paid in. It’s why we have insurance, right, so that we don’t have to pay the whole ginormous cost of examinations, treatments, medications, devices, etc., etc? Yeah, that’s all real swell but there’s a good reason, maybe several, why you should consider not using your insurance for your psychotherapy/psychoanalysis/mental health treatment. Can you guess what it is?

Money? No. That’s not it. Yeah, sure, I can ask for more money from you if you pay out-of pocket than the fees that the insurance companies “negotiated” in the contract for “par” situations. Even if I can charge you more if I’m non-par because I don’t have to accept the rate the insurance company wants to pay, it’s still not about the money.Please believe me on this.

OK, I’ll give you a hint: look at the title again. The part that says “…Privacy of Our Work Together.” That’s my big concern and needs consideration on your part before you simply say “I pay for the insurance and I want to use it where ever I can.”

Have you stopped to think about how I get paid or you get reimbursed? Of course you have. I do something that goes to the insurance company and they send me a check (or deposit to my account) or I give you something, you combine that with something else, send it to the insurance company and they send you money. Simple. As easy as 3.1416.

Not so fast, Kimosabee. What’s on that claim form that goes to them? The CPT code (that tells them what procedure was performed, e.g., 90806= O(ut)P(atient) psychotherapy, 45-50″ (minutes,) no med(ication) eval(uation.) That tells them how much they pay out for what went on in the room. We can all agree that this is pretty harmless and doesn’t really do much in the way of leaving an artifact, right? Wrongo! Let’s move on to part II of this and I’ll explain more. For now my tea is ready to brew. See you in a bit!