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Have you ever seen a therapist? If so, did you ask for your diagnosis? Did asking for such a thing cross your mind? If it did not, or if you simply forgot to ask, you may want to read this article. Your insurance premium may depend upon what you learn in the next five minutes.
People often choose to use insurance to pay for their mental health services. This is a fairly routine thing that most people do without thinking twice, but there is one important pitfall that you should be aware of:
Always know your diagnosis.
In order for a therapist to be paid by your insurance, he or she must make a diagnosis and share that information with your insurance company. Insurance companies often will not pay for what are considered minor conditions like bereavement or certain anxiety disorders.
This presents a problem if you cannot pay by cash or check because the therapist needs to be paid somehow. If insurance is your only option for payment, your diagnosis might get inflated so that the therapist can get paid. While this does not happen often, the potential is very real.
What does an inflated diagnosis mean?
Well, let us say for example that you very recently lost a loved one and are experiencing sadness and grief over the loss. This sadness begins to affect your work and personal life negatively, so you decide to seek counseling for support and guidance. Because you have limited income and cannot pay by cash for therapy, you decide to use your health insurance.
In this example, your therapist should diagnose you with Bereavement. However, that diagnosis is considered minor, and your insurance will not likely pay for your counseling sessions. As such, your therapist might quietly inflate your diagnosis to Major Depressive Disorder, Recurrent, Severe without telling you because that is a diagnosis that your insurance company will pay for.
Unfortunately, this significant diagnosis will likely have a negative effect on your insurance record that will go unnoticed until months or years later. This is obviously fraud and corrupt behavior on the part of the therapist, but it happens more often than medical professionals care to admit.
Why is it allowed to happen?
In mental health agencies, interns and post-docs who are freshly exposed to law and ethics expectations rarely question diagnoses because they are afraid of being disciplined or fired for speaking against their clinical supervisor’s diagnostic impression. Also, some therapists may see insurance fraud as a necessary evil in the helping profession. They can get away with this because most clients express no interest in learning about their diagnosis.
Corruption and fraud exist in many fields, and this kind of fraud would likely have an effect on your personal health and insurance record. There is nothing to stop an insurance company from raising your premiums due to a significant mental health diagnosis. The only thing stopping a medical or mental health professional from reporting an inflated diagnosis to your insurance company is you.
So, what can you do to protect yourself?
1. Ask for your diagnosis and an explanation of that diagnosis. Clearly state to your medical or mental health professional that you do not want the name of the diagnosis or the explanation “dumbed down.” Be wary if you hear something like “clinical depression” or “manic depressive disorder” as these are not professional labels for mental health conditions.
2. If your diagnosis does not make sense, ask for further clarification or go on the Internet to read more about it.
3. Armed with this new information, get a second opinion!
4. Ask to see your medical record to confirm your diagnosis. If something in your record does not make sense, ask for clarification.
A little paranoia about the accuracy of your diagnosis is a good thing, so be an advocate for yourself!
Medical and mental health professionals have absolutely no right to keep your diagnosis or your medical record from you, but it is your responsibility to ask for your diagnosis. At any time, you may request to see your record with your therapist. If your medical or mental health professional is disinclined to accept your request to see your record immediately, it may be time to consult an attorney.
The information in this article applies to anyone who seeks mental health services, but your insurance record will likely be impacted in some way only if you choose to use your insurance as payment for therapy.
If you choose to pay by cash or check, your mental health record with your therapist is considered confidential information by law and your insurance company will not be able to access it without your permission.
Stephen Brewer, M.A. is a registered psychological assistant (PSB33858) in Scripps Ranch and is supervised by Angela Spenser, PhD (PSY15450). He runs a LGBT and kink-friendly practice, specializing in addictions, trauma, HIV/AIDS, and men’s issues. He can be reached at (619) 377–3120 or you can visit his website at www.therapybrew.com.