Not ready to out my crazy yet
August 10, 2013 6:34 PM   Subscribe

Can you get a psychological evaluation "off the record"? Would that be as simple as private pay?

In the last several years, various friends and family have diagnosed me as having more than one fairly serious psychological malady. I would really like to get something like an objective assessment of just how fucked up I actually am, but I am not ready for any of that to be a matter of record for insurance companies and employers.

Also, given the foregoing, would I want to be evaluated by a psychologist, or a psychiatrist? Any advice on choosing the appropriate professional?
posted by Mr. Spock's Muppets' Socks to Health & Fitness (6 answers total) 3 users marked this as a favorite
FWIW, I know a normal everyday person who pays out-of-pocket for certain doctor visits, as s/he wants to know what the result is, without being obligated to share that information with anyone else. That person could conceivably be committing insurance fraud if s/he changed hir policy in view of such knowledge, without disclosing it to the insurer, but s/he is apparently comfortable doing so -- at least, s/he is more comfortable than s/he would be doing the excruciatingly ethical thing of warning the insurer before seeking treatment, and then accepting the "preexisting - not covered" determination thereafter.

posted by spacewrench at 7:09 PM on August 10, 2013

Records: Any mental health professional is required to keep records, but if you don't use your insurance, then they're unlikely to have to share those records with anyone. Exceptions would be a court case in which your mental health comes into question and there's a court order for the records, or mandated reporting issues like admitting to child abuse or homicidal plans (in which case the entire record would most likely not need to be shared).

Type of Professional: It kind of depends on what you think you're likely to be diagnosed with. I think you're likely to be good with either a psychologist or a psychiatrist, but one thing psychologists are specifically trained in is giving and evaluating tests/assessments, so if it's something testable (ADHD, cognitive deficits), I'd probably advise seeking a psychologist. If it's more on the depression/anxiety scale, or if it's on the other end of the spectrum and you think you might have a personality disorder or some sort of psychosis -- basically, if it's either a fairly common or a really uncommon issue -- then I think a psychiatrist might be more helpful, because they see a lot of the common stuff and likely have more specialized training for the uncommon stuff, plus they can prescribe medications necessary for treating the uncommon stuff.

But, really, either would probably be fine. And if one professional can't help you, even just with assessment, they can probably refer you to someone who can.
posted by jaguar at 7:10 PM on August 10, 2013

There is no way you can have this done under your usual name and be guaranteed that no insurance company or employer will ever, ever find out about this visit. You'll want to put some thought into just how off the record this needs to be for you to be comfortable, Mr. Socks.
posted by yohko at 7:21 PM on August 10, 2013

Best answer: It is completely illegal to disclose any medical or psychiatric condition to anyone, even to confirm that they have ever been treated or sought care, unless there is clear evidence in favor of disclosure such as a public health risk (active tuberculosis, HIV and married, meningitis etc) or the patient has made clear statements regarding their intent to kill themselves or someone else. Granted, I'm sometimes shocked at how much information is sent to the insurance review, but some doctors are very careful about being deliberately and creatively vague in that area, so it's not a given.

If you don't disclose that you have health insurance and would like for your information to remain confidential there's no reason why you can't request a psychiatric intake and evaluation, or whatever the psychologist equivalent is, under a false name, even, and pay in cash. Even if you gave your own name and paid via credit card there's no way for this information to be propagated to the government, insurance, your boss, wife, inheritors etc. It's been done before, it's practically tradition in some parts of the country. Most lower tier health insurance doesn't even cover services falling under mental health, anyway. What you tell your insurance company the next time they ask you about previous diagnoses is up to you.

There's about a thousand caveats and footnotes I could add about the limitations of how this would benefit you and how psychiatric diagnosis isn't quite so cut and dried, but I'm sure you realize that.
posted by hobo gitano de queretaro at 9:10 PM on August 10, 2013

Just a side note suggestion:
Make some notes or keep a diary/journal about factors in your behaviour that you think may be contributing to your friends/family lay-diagnoses prior to seeing a diagnostician. Having some background info may really help your chosen therapist make a more rapid diagnoses, if rapid is what you want.

I think the whole pre-existing thing is reprehensible. Life is a pre-existing condition. And if they could, I bet US insurance companies would prefer to insure only dead people who can't make a claim. So FWIW, I, an unknown person on the internet, will not think badly of you in anyway if you choose to keep this off the books to avoid the pre-existing rule.

As for psychologist/psychiatrist - are your suspected condition/s usually treatable only by meds, or by therapy and meds, or therapy only? Personally, I'd see a psychologist first, then see if they recommend a psychiatrist.
posted by Kerasia at 9:57 PM on August 10, 2013

A friend of mine was in a car accident. The insurance company for the other side demanded to see her full medical history. She asked her lawyer if she could just send the medically relevant details for the injury case. He told her that she needed to release everything or it would look like she was hiding stuff. And she was in tears and pointing out that she had been told her records were private. But the lawyer said it was private but needed for a court case. And, so, because she was screened but not diagnosed by a psychiatrist a few years before, the lawyer from the other side started alleging that all her symptoms were related to anxiety and depression. The case never even went to court, but now the insurance company has a copy of all her medical history. Fortunately, they settled out of court, but it still upsets her that her medical history is out there and they used her psych records against her when she wasn't even diagnosed with anything.
posted by Chaussette and the Pussy Cats at 10:03 PM on August 10, 2013 [1 favorite]

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