Mental health services paid out-of-pocket: to tell or not to tell?

February 26, 2008 5:31 PM

If I have paid for mental health services out-of-pocket, should I leave those things off of any history forms I fill out when applying for individual/private health insurance? Will the insurance companies find out?

I've read the old threads on this...many people say to pay for mental health services out of pocket because otherwise you may be denied health insurance coverage later on. But does that mean I should lie on any forms I fill out when applying for coverage later on, pretending that any meds/shrink appointments that I paid for on my own just didn't happen? If so, how is it that insurance companies don't find out about those--can't they look at my medical records? Ehealthinsurance.com says "During the underwriting process, it may be necessary for the insurance company to review your medical records. " And if I get caught in my lie-by-omission, what happens? Wouldn't that be even worse? I feel like I must be missing something here.

This is in the US, naturally.

extra bonus question: if I should omit the mental health care...last year I began filling out an online application for insurance, filled in some of the mental health stuff, saved it, but never went back to finish the application. What's the chance that information has been saved or shared with other insurance companies?

posted by anonymous to health & fitness (13 comments total)

Paying for them out-of-pocket works best if you are using a doctor/therapist/pharmacy unconnected with your regular doctor or insurance plan. They can't look at your records if they don't know who to ask. The other reason for paying out of pocket is protect your privacy - the insurance company ends up finding out a lot of about you if they are paying. Plus they will only pay for care that they think is necessary. Many therapists won't accept insurance for that reason.

For my family, we ended up using insurance for prescriptions and hospital stays (both very expensive) but not the actual therapy.

The most likely to thing to happen if you include it is that they exclude coverage for these expenses (probably for a limited period of time). This varies from one insurer to another so gets lots of quotes. On the other hand, if they find out later that you lied on the form I think they can come after you I do remember that on West Wing, Mrs. Bartlett got in trouble for lying on her daughter's health forms. (However, that isn't nearly as accurate a source as Wikipedia or The Daily Show)
posted by metahawk at 6:30 PM on February 26, 2008

ps. HIPPA prevents exclusions if you have had continuous "creditable" coverage but only applies if the new coverage is group or employer policy, not an individual one. Individual policies are covered by state law. It looks like you can find state by state details at National Assoc. of Healthcare Underwriters. Most seem to have a maximum "look back" of 12 months so if your treatment was more than a year ago, you may be safe.
posted by metahawk at 6:41 PM on February 26, 2008

HIPPA has changed a lot of the conventional wisdom on insurance. It makes portability a lot easier.

No, they probably won't catch you, and will probably sign you up just fine. But a year from now if you cost them a ton of money, they just might go back and "verify their records." What that means is they investigate to see if you lied anywhere on your application so they can cancel your policy for cause. Not cool, but within the rules since you would have lied.

Always tell the truth on things like this, the consequences are way too big if you get caught.

OR, get your super-secret medical treatment under a false identity. I do not believe that's illegal, if you are not knowingly impersonating someone and are not intent on defrauding anyone. You are just interested in privacy. It probably is illegal if you are getting prescriptions, however.
posted by gjc at 7:14 PM on February 26, 2008

You're paying for insurance so that in the unlikely event that something bad happens to you that you can't afford to pay for yourself, the insurer will pay instead.

In other words, the whole point of insurance is to convert risk into expense.

If you fail to disclose relevant information to your insurer, you're just converting risk into risk and expense.

Lying to insurance companies is self-defeating. Go full disclosure, and if you're not happy with the resulting level of expense, change insurers.

Of course, given that you live in the US, picking an insurer is like choosing between sharks and moray eels, so while health insurance is on your mind, consider carefully the options being offered to you by the current round of presidential candidates.
posted by flabdablet at 7:20 PM on February 26, 2008

I can't advise you but I will tell you that a relative disclosed that he went through drug treatment talk therapy and he was denied coverage for attending a group addiction meeting at a hospital once a week. His whole family was denied, it was a family plan. I think it is outrageous that it is held against you by an insurance company if you sought help for something in the past, but there you go.
posted by 45moore45 at 7:38 PM on February 26, 2008

Flabdablet, in the US most people DON'T HAVE THE OPTION TO CHANGE INSURERS - they've got company-provided, or they got nuthin'.
posted by notsnot at 8:05 PM on February 26, 2008

Oh, I meant to add: the insurance companies will find any way possible, and many impossible ways, to fuck you and then rube the wound with salty sandpaper. Feel no regret whatsoever in not letting them know.
posted by notsnot at 8:06 PM on February 26, 2008

So this is rubbish, then?
posted by flabdablet at 8:17 PM on February 26, 2008

Well, we do have the option to change insurers, but we would have to pay full price for it, while our employer is also paying for a policy.

Don't lie, in this case it is an automatic "go directly to jail" card. If you tell the truth, you might have to pay some out of pocket. If you lie and are caught, you pay everything out of pocket. That is bad advice.
posted by gjc at 9:21 PM on February 26, 2008

It's not *rubbish* flabdablet, but "possible" doesn't mean "actually an option for most people".
Yes, it's possible to buy insurance without your employer. However, most people get a "discount" on the work-based plan because A) the employer makes a contribution (note this part - "In 2007 the average employee contribution was 16% of the cost of single coverage and 28% of the cost of family coverage.") and B) big employers get a group rate so the cost per policy is greater to begin with. While "the range of products available is similar to those provided through employers. On average the deductibles, co-payments and other beneficiary cost-sharing provisions actually purchased are higher, however."
BASICALLY, most of the time, most states, if you want to go outside your employer's plan, a comparable plan would be prohibitively expensive. Expensive like another mortgage. So most people who don't (or can't) participate in work coverage just get a catastrophe-bulwark, super high deductible situation that doesn't cover mental health (or prescriptions, or ER visits) anyhow. I think that was notsnot's point.
(note: writing this comment has been so much fun! talking to someone outside of the states about our health insurance situation is like talking to someone from space! it's such a crippling, obvious, career-path-hemming problem for everyone I know).
posted by moxiedoll at 9:24 PM on February 26, 2008 [3 favorites]

flabdablet- My mom wants me to marry my boyfriend asap. She likes the guy, but she also wants to see me on his health insurance. I don't have health insurance, and I can't afford it- right now. Once I move up the career ladder enough to afford insurance, my (future) employer would likely pay for a big chunk of it.
posted by Monday at 9:36 PM on February 26, 2008

moxiedoll: I like the words you choose... "it's such a crippling, obvious, career-path-hemming problem for everyone I know."

That's the main point I try to make to people about socialized medicine.. it's not that you get better care, or better technology.. it's that your medical coverage is not a significant factor affecting the decisions you make in life. You just don't worry about it.
posted by TravellingDen at 9:39 PM on February 26, 2008 [1 favorite]

There is not (yet) any sort of omnipresent National Medical Records Database that insurance companies can just peek into and figure out what you've been talking to your therapist about. If you paid your therapist in cash, the only people who necessarily know you were there are you and them – meaning you should ask them pointedly and specifically about their privacy policy (they're required by law to maintain confidentiality but I think you should ask anyway, and while you're at it remind them that you haven't authorized them to disclose any information to anyone, including confirming or denying whether you've ever been a patient).

Without knowing exactly what sort of privacy precautions you took and how lax your provider is with privacy, it's nearly impossible to accurately gauge the risk of someone figuring it out down the road. You'll have to do that yourself: put yourself in the shoes of Evil Insurance Inc., and think about how many crumbs you've left (sounds like you've started to do this already). Consider who knows of your treatment and what they'd say if someone official-sounding from an insurance company called them up and started asking questions: don't assume any good faith, common decency, or morality on the part of the insurer.

While I'm not advising you to lie, I don't think it's impossible in the abstract to imagine a situation where, after careful assessment of the risks and costs involved, not disclosing may be the most advantageous option. (Especially if the alternative is definitely no insurance at all now, versus possibly no insurance at all later.) However, if there's a good chance you may do something that will trigger an investigation down the road but within the 'look-back' timeframe, failing to disclose now may be something you'll regret later.

As ridiculous as it sounds, you may want to seriously consider having your records in the future for sensitive treatments (the ones you pay for in cash) maintained under a pseudonym and modified DOB. (And of course, don't give out your SSN; they have no reason to need it.) If you're paying cash in order to retain the privacy option down the road, no sense in halfassing it.

I'll leave aside the whole moral/ethical issue of failing to disclose to an insurance company, except to say that personally, given that most big health insurance companies would quite literally kill you to save a few bucks given the opportunity (and were it legal, I've no doubt they'd probably cut you up and parcel you out to the highest bidder as 'cost recovery'), I'm certainly not going to fault anyone for taking any advantage they can get. At the very least, it's not a black-and-white issue.

Good luck.
posted by Kadin2048 at 9:41 PM on February 26, 2008 [1 favorite]