It is extremely important for those receiving benefits under the mental & nervous provisions of their policy to be aware of an unfortunate circumstance that could result in the denial of claims. While it might seem to be totally unfair, let me reassure you that it definitely is.
The process of treatment for mental health and claims reporting coincide when it comes to private disability. Claimants and insureds attend regular therapy sessions and literally bare their souls to another human being who will write all the detail down in what’s called “patient notes”. These same “actual psychotherapy notes” are sent to an insurance company that is well aware of the “bare the soul therapy” source who will then use them against claimants and insureds to deny claims.
The problem is that insureds suffering from mental health issues should share their deepest thoughts and anxieties so that the therapist can provide appropriate treatment. The relationship between therapist or psychologist should be one of trust and complete confidence. If everything you say is then provided to an insurance company looking to limit or deny your benefits, how truthful and honest should you be?
Insurance companies aren’t dumb and claimants should not make the mistake of thinking they are. They know the fragile relationship between therapist and patient, and take full advantage of it.
It is important for mental health disabled persons to understand that while therapists may be doing a great job, they aren’t usually knowledgeable about disability claims unless they’ve dealt with them in the past on multiple levels. When asked to do so, many therapists just send insurers the “actual psychotheapy notes” without even thinking, or reading the Authorizations; and, there goes your entire life sitting on top of a claims handler’s desk.
Therapists are NOT REQUIRED TO PROVIDE ACTUAL PATIENT NOTES EXCEPT IN THE CASE OF SUBPOENA. Your therapist can simple say, “I do not provide actual therapy notes to any outside third parties, however, I am happy to provide mental restrictions and limitations in summary form.” “Summary form” means filling out a form. While insurance companies may cause you and your therapist to think they are required to provide the information, it simply isn’t true.”
It is very important for all insureds to discuss with their therapists what to do when requests for patient notes from insurers are received. Your therapist can send a fax stating the above, but most importantly, there should never be a doc-to-doc call, and clearly, the notes are not to be provided. Patient notes belong to the therapist; they are NOT required to send them. This does not at all relieve your therapist from the responsibility of supporting your disability on a form, but it does mean the therapist can refuse requests to provide the notes.
There have been insurers in the past who have INSISTED on reviewing patient notes even when they are making out-of-contract requests. Prudential Financial is an expert in using patient notes to deny claims. I once had a claim that was denied when a female client’s notes said her boyfriend was living with her, but he wasn’t working. Another claim was denied because a very prominent client admitted to his therapist they he parked in the woods to have sex.
But, it is often more than this. Another example is that of a physician who told his therapist that he was planning to fly to Texas to visit relatives. The notes described how proud he was of himself to be able to fly on a plane without someone else accompanying him. Flying on a plane is always considered to be at least “Light work capacity,” and visiting relatives also indicates the ability to work. This is all the insurance company would need to see in order to deny a claim for “does not meet the definition of disability….has work capacity.”
There must be a discussion with your therapist either to NOT document life’s situations, feelings and activities, or NOT provide the notes when requested to do so, or maintain a second set of notes. After all, how honest would you be in your therapy sessions if you knew everything you said would be seen by an insurance company?
We all have different personalities. Some of us are not great talkers, we keep silent, but there are others who talk incessantly without taking a breath. And, by the way, to be clear, this is what therapy sessions are for. Sharing and talking about your life. You aren’t doing anything wrong by speaking your truth to your therapist. BUT……
You do have control over where the information goes, and how it is used after-the-fact. If you do nothing, but censor your discussions with your therapist, then I would question the overall value of the therapy.
My advice is to speak with your therapist about what you want to happen to your actual psychotherapy notes. And, my recommendation is not to agree to release them. If you want to receive valuable therapy, you need to be able to speak honestly in your therapy sessions without having that information released to entities who intend to harm you.
