You and I are beginning a collaborative relationship: we will be working together to achieve your therapeutic goals. There must be a good level of trust in our relationship in order for our work to be effective. Confidentiality is one important part of that trusting relationship. Please read the following points carefully and discuss with me any questions or concerns you may have.
- As a Licensed Independent Clinical
Social Worker, I am required by law and by my profession's Code of Ethics
to maintain everything I know about you in strict confidence. That means
I cannot reveal your name or anything else about you to anyone else without
your explicit authorization to do so. There are only four relatively rare
exceptions to this standard: if you are in imminent danger of killing yourself;
if you make serious threats to kill someone else; if I have reason to believe
you are abusing or neglecting a child; or if I am subpoenaed to testify
about you in court.
- Although many people don't realize it,
you have signed over your right of confidentiality to your health insurance
company. That means that you have given your insurance company authorization
to obtain any and all information I have about you when you request
them to pay for any of the services I provide to you. It used to be that
insurers only wanted your name and other identifying information, your
"diagnosis" (a numeric code indicating the kind of problem you are getting
help for), and the dates and types of service I am providing to you (eg.
individual or group therapy). Nowadays, it is common for insurance companies
-- and the "managed care" companies they utilize -- to require very detailed
information about your personal problems and background, and even to see
your entire file. If they don't get the information they want, they will
generally not pay for the services you receive.
- Insurance and managed care companies
put this information about you into their computer files. These companies
change ownership frequently. Little companies are bought by bigger ones.
Other companies merge. And insurance companies sometimes change which managed
care organizations they utilize. The information these companies have gathered
about you is passed on to different owners and contractors with each of
these changes.
- Depending on the contract your employer
has made with your insurance and/or managed care companies, your employer
may be informed by these companies that you are receiving therapy. (You
may want to check with your personnel department to see if this applies
to you.)
- More and more every year, health insurance
plans are handled by "managed care" companies. This is for the purpose
of saving money, especially for the employers that are paying for most
of the insurance. The rapid growth in managed care has had some positive
effect in slowing the rising costs of health care, a very worthy goal indeed.
But managed care companies are an extra layer of bureaucracy that cost
a lot of extra money. In order for managed care companies to save money
and make a profit -- their bottom line as for-profit businesses -- they
actively attempt to limit the services you receive. In order to do that,
these managed care companies have become increasingly involved in making
the decisions about which mental and physical health care services you
may obtain.
For example, you may have been led to believe that you are entitled to 25 therapy sessions per year to be used as you and your therapist see fit. But your managed care company may only give me permission to provide you with four to six therapy sessions, and only to take care of certain problems and not others. (Generally, managed care companies only cover problems that they consider to be "medically necessary;" they are very reluctant to pay for services aimed primarily at improving relationships or self-esteem.) I will probably have to give them a great deal of personal information about you and your problems in order to get more sessions authorized. And increasingly, they say "no."
- Some managed care companies even provide financial incentives to doctors and therapists to provide you with fewer services. For example, these companies may pay a therapist more per session when that therapist provides fewer sessions per client. I consider such practices to be unethical because they place the profitability of the company above the health care needs of the client. I will not serve on the panels of managed care companies that engage in these practices.
If you have any questions or comments,
please email: Larry Cohen.