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molly121 · Jan 9, 2009, 12:46 PM

Hi All. My Psychiatrtist was asked to relsease all my records to my insurance company I have said no, I don't want them released to anyone AT ALL. Will my doctor get in trouble for this? How much can my insurance company ask for? My doctor has already given them the PCT codes so he can get paid, I don't want anyone looking at my personal chart that has his notes!! Now I am afraid they will deny payment for my therapy because I won't let them look at my chart! Too much information on there-Any thoughts!

Eelarch · Jan 9, 2009, 12:53 PM

Isn't there a law on doctor patient confifentiality?

LearningAsIGo · Jan 9, 2009, 01:44 PM

Insurance companies (I assume you're in the US) have a right to look at medical charts. They are bound by HIPAA so they cannot release themselves or discuss your information, but they are allowed to access them.

They do this for one purpose only: To verify what your doctor is charging. This is the only way doctors get paid and the only way insurance will cover your costs. For your doctor to just send the J-codes/CPT codes to the insurance is not enough. Without your chart for accountability, he could try and charge whatever he wanted -- your chart is verification of his charges.

I'm sorry, and I understand your concern, but that's the industry standard.

molly121 · Jan 9, 2009, 01:48 PM

Yes, and yes! There is a hippa law- but my doctor has already given them the codes they need- ie: what I have been diagnosed with and the charge. I don't see why they need to see additional chart notes from private sessions when they already know what they are paying for- it makes me uncomfortable.

LearningAsIGo · Jan 9, 2009, 01:59 PM

Let me clarify about HIPAA.

Those laws are to protect individuals so that their medical information cannot be discussed with anyone not related to their care.

Unfortunately, insurance agencies ARE directly associated with your care.

Basic billing means the doctor's office will send along your diagnosis code and procedure and/or medicine codes.

99% of the time, that is not enough to the insurance company.

For example, say an unethical doctor has Sally Jones in his office. He talks to her about an ear infection, but he knows that insurance will pay more money if she is diagnosed with cancer. So, he submits a code for cancer...
The insurance company looks at the chart notes and sees that is NOT what she was treated for.
--Insurance companies can't afford to trust every doctor. They don't want to pay claims, so they pay employees to audit charts and verify charges.

Also, billing can come down to the exact time you were in the office with him. If you had a 30 minute appointment, the charge is $xx.xx If you spend 44 minutes in his office, the charge is $xxx.xx
All of these things can only be seen by looking into your chart.

There really is no way around this unless your doctor accepts cash and you can afford to pay him that way.

molly121 · Jan 9, 2009, 04:07 PM

Sigh*Thanks for your expertise! I guess there is no way around it. I sort of thought going to a Psych was like going to a preist- that it was in TOTAL confidence. Oh well. Live and learn!

J_9 · Jan 9, 2009, 04:11 PM

Now, be assured, many of the doctors notes will not be copied and submitted to the insurance company. Psychiatry has a slightly different code of ethics and there are portions of the file that are kept in confidence unless requested via a court ordered subpoena.

Most likely the insurance company is just asking for specific portions of your records to back up the billing... not the actual doctor's notes.

Wondergirl · Jan 9, 2009, 04:20 PM

Originally Posted by J_9

Now, be assured, many of the doctors notes will not be copied and submitted to the insurance company. Psychiatry has a slightly different code of ethics and there are portions of the file that are kept in confidence unless requested via a court ordered subpoena.

Most likely the insurance company is just asking for specific portions of your records to back up the billing.....not the actual doctor's notes.

You are correct. Case notes (the psychiatrist's or counselor's session notes) are kept in a locked drawer, different file, from the rest of the client information that is kept regarding appointments and billing. It would take a court order to get case notes, and there are ways around having to submit them. There is no need for worry about private confidences hitting the street.

WG, a counselor who took ethics classes in grad school, worked for Catholic Charities and at one of the Nat'l Council on Aging sites, and now works as a counselor as an independent contractor

molly121 · Jan 9, 2009, 04:47 PM

Hmmm, this is getting interesting. I appreciate everyone's input. I personally feel the doctor should just be able to bill with codes and that's it. I was under the distict impression that whatever was told to my shrink behind closed doors was strictly in confidence (no, there is no reason for a billing person to know about my childhood). It's bad enough that there are a ton of people that need to be privy to my medications!

Fr_Chuck · Jan 9, 2009, 10:31 PM

If you order the doctor not to give them, he should not, but it is very simple the insurance company then just won't pay for the bill, so get the check book out, pay for it yourself.

If and when you turn it over to the insurance company they have a legal right to review the actual treatment records, not just the codes if they wish to.

J_9 · Jan 10, 2009, 09:24 AM

Originally Posted by Fr_Chuck

If you order the doctor not to give them, he should not, but it is very simple the insurance company then just won't pay for the bill, so get the check book out, pay for it yourself.

If and when you turn it over to the insurance company they have a legal right to review the actual treatment records, not just the codes if they wish to.

While this may be true with medical records, psychiatric records are an entirely different animal. There is a different set of laws that govern psychiatric records.

Wondergirl · Jan 10, 2009, 09:35 AM

Originally Posted by J_9

While this may be true with medical records, psychiatric records are an entirely different animal. There is a different set of laws that govern psychiatric records.

I agree and said as much earlier in this thread. Billing and other information needed for the insurance company is kept in one filing cabinet, while case notes and other confidential info is kept in another LOCKED file. Only a court order would be able to shake loose that file, and the therapist will do everything possible to keep that from happening.