Although I’ve written about this issue for approximately ten years, I find it continues to happen so often that the subject is worth mentioning again. This is an issue insureds disabled with behavioral issues needs to pay particular attention to.
Unum is in the habit of sending its general company Authorization to mental health providers requesting patient psychiatric notes. Of course, most treatment providers do not actually read the Authorization, which clearly (in the third paragraph) says “does not include psychotherapy notes and they send them anyway.
Unum has been getting away with this for a long time. In my opinion, it’s not done deliberately, but Unum’s claims handlers are not trained very well and are not told there are two separate Authorizations, one specifically for Psychotherapy notes. Therefore, the wrong Auth is sent, and in combination with the fact that therapists don’t read it, psychotherapy notes are sent – albeit without proper insured Authorization.
DCS rarely recommends sending actual psychotherapy notes to any insurance company because they are used to misrepresent and undermine the severity of insureds’ conditions. Therapy notes are not written to validate disability, but rather represent reminders to the therapist of what transpired in the counseling sessions.
Most therapists and psychiatrists today recognize that patient notes are abused by insurance companies, and establish office policies and responses such as, “This office does not release actual psychotherapy notes to any outside third-party.”
This means that the therapist must only release private notes with a subpoena from a judge in the case of litigation. HIPAA amendments have given behavioral health therapists a great deal of decision-making authority to decide not to disclose their personal notes.
Insureds and claimants receiving benefits due to mental health should always provide their therapist AND psychiatrist with a copy of Unum’s Authorization and point out where it says, “does not include actual psychotherapy notes.” Insureds who do not want their patient notes disclosed should discuss the Auth with their treatment providers.
This does not mean that mental health insureds do not have to provide restrictions and limitations precluding work due to behavioral issues. Quite the contrary. Therapists could respond to the insurance company in the following way: “This office does not provide actual psychotherapy notes to any outside third-party, but will continue to provide behavioral restrictions and limitations in summary format” This means filling out forms.
Please note I am only speaking about psychotherapy notes, not medical notes. Patient notes supporting a physical disability should always be provided to insurers when requested.
DCS objects to providing psychotherapy notes to insurers because doing so minimizes the value of therapy. Therapy sessions are only helpful to the insured if he/she feels comfortable to share private issues about their lives and those with whom they come in contact with. Counseling sessions are intended to be private and confidential.
If it were known that records of therapy sessions were provided to an insurance company, patients would “hold back” valuable information from therapists fearing how insurers might misrepresent the information. DCS is of the opinion that all mental health patients should feel comfortable with sharing their thoughts while receiving therapy. DCS also objects to disclosing personal notes because they are not written with the intent of validating disability claims, and do not fulfill that purpose.
Anyway, mental health insureds need to make sure the treatment providers are aware that not all Authorizations provide for the release of actual psychotherapy notes. Unum in particular has a separate Authorization for psychotherapy notes, which most insureds do not sign. You want to make sure your providers aren’t releasing information you didn’t authorize.
Finally, all patients have the right to receive the full value of their therapy without the information being read by many people within an insurance company. Please make sure your treatment providers are aware of this issue.