Will the tinfoil hat also cover up my crazyness?

January 3, 2008 8:44 PM

What is the privacy downside of seeing a therapist using my insurance plan?

OK, I need to do something - and probably seeing a headshrinker is a good start. I am covered by my employers insurance plan through CIGNA:
http://apps.cignabehavioral.com/home.html

However, I am a bit of a nut (so to speak) regarding privacy, and based on my career, it is not unlikely that I will have to eventually get government security clearance.

What kind of information is shared between my shrink and anyone but me (employer, insurance company, [any others?]), assuming I am not a threat to myself or anyone else? Does this kind of thing derail careers? Prevent the NSA from trusting you? Should I just pay out of pocket and not give correct personal information?

posted by anonymous to health & fitness (7 comments total)

Check out the info at this site re the hipaa laws.

But...all laws aside, if you're looking to get a job with some sort of security clearance, you might want to pay out of pocket and have a clear understanding with the therapist that he/she is not to release info to ANYONE. That's the best you could do...but, will it be enough? In this country...who knows.. I don't think anyone here can answer that part of it..
posted by HuronBob at 9:01 PM on January 3, 2008

Just with regard to the security clearance issue, I went through that process a few years ago. You could pay out of pocket and keep them from knowing that you saw the therapist, but the way they ask you about therapists is that they just ask you who you have had and you provide a list - if you didn't disclose it, it's a violation and can be grounds for revocation of the clearance. When you do your polygraph (and yes, I am aware of the ridiculousness of such measures) they will ask you many times whether you have been completely truthful and complete in all the information you have provided.
posted by ecab at 9:09 PM on January 3, 2008

Oh, and to add to what I just said, to get your clearance, as part of the review, you have to sign a document that allows the government to look at all of your medical records, both from your physicians and your therapists. If you don't release that information, you can't get clearance - at least that was how it was presented to me.
posted by ecab at 9:14 PM on January 3, 2008

IANAP but I have three family members who are psychologists and one more on the way. . . they've told me anecdotes of seeing other psychologists or therapists and/or their spouses or children and getting paid out of pocket so that there will be no record on them.

Anecdotally, in California at least if action is taken against a therapist their mental health history is automatically subpoena'ed and used in evidence.

Anon, if you're in California, a recent law allows therapists to keep two sets of records, of which only one is subpoena-able. I don't remember the law, but if you contact me via my profile I'll get the name from my family members. Two of the psychologists I'm related to keep these dual sets of records- one is considered "personal property". They put the really frank notes in there, with a much more polite version in the subpoena-able file.

But this doesn't matter as much as the fact that most employers have access to your medical information, and if you're insured through your employer they will know about your care. Sadly, there is still a stigma attached to seeing a therapist, one that might affect you professionally with current or future employers.
posted by arnicae at 9:27 PM on January 3, 2008

( I know you're more curious about your employer getting ahold of this information, but..)
It could be used against you in a child custody battle if your S.O. knew about it and decided to use it.
posted by Sufi at 9:34 PM on January 3, 2008

The federal guidelines on security clearances, see Guideline I, may be of interest to you. The process has evolved a lot, given the changes in society re MH stuff (far more diagnosis and treatment plus moving away from OMG NUTZ) plus laws such as the Americans with Disabilities Act. Under the current guidelines, run-of-the-mill mental health treatment and conditions are not supposed to raise a huge red flag.

Okay, then, here it is (with a few editorial bolds from me):

GUIDELINE I: PSYCHOLOGICAL CONDITIONS

27. The Concern. Certain emotional, mental, and personality conditions can impair judgment, reliability, or trustworthiness. A formal diagnosis of a disorder is not required for there to be a concern under this guideline. A duly qualified mental health professional (e.g., clinical psychologist or psychiatrist) employed by, or acceptable to and approved by the U.S. Government, should be consulted when evaluating potentially disqualifying and mitigating information under this guideline. No negative inference concerning the standards in this Guideline may be raised solely on the basis of seeking mental health counseling.

28. Conditions that could raise a security concern and may be disqualifying include:

(a) behavior that casts doubt on an individual's judgment, reliability, or trustworthiness that is not covered under any other guideline, including but not limited to emotionally unstable, irresponsible, dysfunctional, violent, paranoid, or bizarre behavior;

(b) an opinion by a duly qualified mental health professional that the individual has a condition not covered under any other guideline that may impair judgment, reliability, or trustworthiness;

(c) the individual has failed to follow treatment advice related to a diagnosed emotional, mental, or personality condition, e.g. failure to take prescribed medication.

29. Conditions that could mitigate security concerns include:

(a) the identified condition is readily controllable with treatment, and the individual has demonstrated ongoing and consistent compliance with the treatment plan;

(b) the individual has voluntarily entered a counseling or treatment program for a condition that is amenable to treatment, and the individual is currently receiving counseling or treatment with a favorable prognosis by a duly qualified mental health professional;

(c) recent opinion by a duly qualified mental health professional employed by, or acceptable to and approved by the U.S. Government that an individual's previous condition is under control or in remission, and has a low probability of recurrence or exacerbation;

(d) the past emotional instability was a temporary condition (e.g., one caused by a death, illness, or marital breakup), the situation has been resolved, and the individual no longer shows indications of emotional instability;

(e) there is no indication of a current problem.
posted by ClaudiaCenter at 10:05 PM on January 3, 2008

I'd be less concerned about security clearance--as I understand it, failing to disclose is the career-killer / security-clearance-revoking issue, so you've got to report it on your clearance application even if you pay cash and there's no paper trail--than I would be about your ability in the future to get insurance on the open market.

If you think that you may ever want to start your own business, be a consultant, take an extended (like year-long) leave of absence to travel the country, or do anything that would preclude having employer-sponsored health insurance, you might be SOL on the health insurance front if you have any sort of mental-health claim. Very few states require health insurance companies to underwrite policies in the individual market, and any sort of mental health treatment at all could potentially make it very difficult or very expensive to get insurance. Slate ran a piece on one woman's difficulties getting insurance after a single psychiatrist appointment for postpartum depression.

Of course, it may be that we'll have universal health care in the next four years (here's to hoping!) and this will all be moot. But if it were me, I'd definitely pay cash and not seek reimbursement through my insurer, because I'd hate to be blackballed from the individual insurance market--that sort of thing could be the stumbling block to ever starting my own business, which makes the out-of-pocket cost for this sort of thing seem worth it, even if it were covered under my insurance benefits.

Just one thing to consider when you're making the decision about insurance-paid versus cash-paid counseling.
posted by iminurmefi at 8:48 AM on January 4, 2008