Friday, October 22, 2004

North Carolina psychiatrists debate how much therapeutic information should be provided to insurers

The tension between patient privacy and an insurer's interest in knowing what is being paid for has led to a significant conflict between certain North Carolina psychiatrists and an insurance company. The Psychiatric Times has a very thoughtful article on a battle raging between two psychiatrists and Blue Cross and Blue Shield of North Carolina.

This is very much a live issue here in Canada. Patients may not be aware of how much information is being transmitted to their insurers and fear of disclosure can have a significant impact upon the therapeutic relationship. At the same time, health professionals may inadvertently provide too much information, resulting in unintended consequences to the patient.

Patient Privacy Battle Hinges on Competing Interests:

"by Michael Jonathan Grinfeld
Psychiatric Times January 2001 Vol. XVIII Issue 1

One of the reasons that details surrounding a clash over the privacy of patients' records in North Carolina are shrouded in secrecy is that there are still aspects of the dispute that, ironically, remain confidential. The year-and-a-half-old battle, which started after a breakdown in the relationship between two psychiatrists and a major health insurer in the region, yielded privacy issues so critical that the American Psychiatric Association and the North Carolina Psychiatric Association (NCPA) ultimately agreed to jump into the fray.

At issue is a conundrum that will ultimately confront every psychiatrist in the nation and will, if not resolved in a way that reconciles competing interests, strike at the heart of mental health care: Can psychiatrists preserve patient confidentiality while at the same time providing enough information to insurers so they can get paid?

Unresolved questions abound: How much information can insurers justifiably request to ensure that health benefits are paid properly? Are benefits payers asking for so much information that they risk undermining the therapeutic relationships between physicians and patients, or, even worse, are they so intrusive that people won't seek care when they need it? Will physicians sacrifice their obligation to preserve their patients' most intimate revelations in order to ensure an uninterrupted income stream? ..."

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