Confidentiality & Insurance

Social Anxiety Help

Larry Cohen, LICSW

Confidentiality, Insurance
& Managed Care


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 written authorization to do so. There are a few, 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 evidence that you may be abusing or neglecting a child or an incapacitated adult in your care; or if I am subpoenaed to testify about you in court, or a court subpoenas my records about you.
  • 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. 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.

For more information about my office’s practices to protect your privacy, click here. For an outline of your rights and responsibilities as a client in psychotherapy with me and my associates, click here. For a description of the payment plans I offer, and my relationship with your insurers, click here.


If you have any questions or comments, please email Larry Cohen, LICSW, with offices in Washington, DC.

Social Anxiety Help is a founding regional clinic of the National Social Anxiety Center (NSAC):