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Confidentiality in the Information Age

By David A. Peters, MFT


The question of confidentiality has always been a major concern in counseling and therapy.  By law, clients of therapists are protected from the disclosure of any information they share with a therapist.  There are a few limitations on this right, such as when a therapist finds that someone is harming a child, or when someone's life is in danger, at which time the therapist is obligated to take action to protect the safety of others. 

But What About Insurance Records? 

When you use your insurance to pay for counseling or therapy, a therapist must tell the insurance company (or its managed care organization) what they are treating you for.  If you are covered by an HMO, the therapist usually must request authorization for therapy sessions from a "case manager" who has control of your benefit.  This case manager is an employee of a Managed Care Organization (MCO), that manages cases for your HMO.  In order to "convince" the case manager of the need for treatment, a therapist often must write out some details of your psychiatric symptoms, history of substance abuse, relationship problems, brushes with the law, and current personal problems.  These are intimate details of your life.  It is easy for your therapist to safeguard the records in his own office. 

But who is safeguarding the records in the HMO's files?  These are often added to national medical databases that you have no control over.  Further, the case managers (and their secretaries) are merely employees of the HMO or MCO and, as such, they change periodically as they move from one employment setting to another.  In our electronic age, case management is often provided from offices in other cities around the country.  So how many people have access to your records?  Even worse, if you work in a health care setting, where your treatment comes from the same company you work for, then some of your fellow employees have direct access to your private records!  Even with safeguards, abuses can and do occur.  And even if no abuse occurs, there are usually three to five people other than your therapist who will be looking at your personal information.  Do you know who they are? 

You deserve complete privacy.  Therapy is most powerful when you are completely free to share with your therapist.  The only way to ensure complete privacy is to pay out of pocket, and bypass your insurance company.  Yes, this is more expensive.  For some people it is worth the extra cost to have true confidence in their privacy.  I offer a sliding scale fee to make therapy as affordable as possible for those paying out of pocket.  Some other therapists do also.  If confidentiality is a big concern for you, ask your therapist about a plan to protect you.

For more on this topic, contact me.

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