Should I submit by psychiatrist bills to my employer?

June 26, 2007 6:27 PM

It's time to submit my out-of-pocket medical expenses to my employer for reimbursement under the pre-tax medical account program. All my receipts are for psychotherapy, psychotropic medication, and other indicia of mental illness. Is it professionally "safe" for my employer to have this stuff?

Does anyone know of a reason why I should not do this? If I don't put in these receipts, I lose the payroll deductions forever. But mental illness still carries a stigma in the workplace. I'm an attorney at a fairly large firm, if that matters, and the person in payroll processing these receipts has no idea who the hell I am.

posted by anonymous to Work & Money (15 answers total)

Do you have to submit them directly to the company? When I had AFLAC, we submitted the receipts directly to AFLAC. They informed the company how much reinbursement I was entitled to and the company wrote the check. As far as I know, nobody at the company actually saw the receipts. Is there a way you could do something similar?
posted by rcavett at 6:45 PM on June 26, 2007

Does anyone know of a reason why I should not do this?

It all depends on how gossipy the person in payroll is and who they're gossipy with. Most law firms tend to be cutthroat, so it's easy to imagine them letting you go, "just in case" you do something and to rid themselves of any legal responsibility. Plus some alpha male lawyers will take it as a sign of weakness if they find out and pull all sorts of games.

If you can afford it, it might be easier to keep it to yourself.
posted by Brandon Blatcher at 6:48 PM on June 26, 2007

Yeah, I'm with rcavett, I submit mine directly to Conexis, my employer doesn't see a thing. Go online and see if the provider has a place where you can check your FSA account balances and perhaps submit a claim online.
posted by corpse at 7:09 PM on June 26, 2007

Mine went straight to the FSA provider, with no detour through HR.
posted by padraigin at 7:10 PM on June 26, 2007

What's the diagnosis and what kinds of medications? IANAL (and not even an office worker), but (as far as I can tell) in the non-legal world depression treated with talk and say Lexapro is so common it's almost expected, while taking Risperdal because The Voices keep telling you to STAB THE BALDY still carries some stigma. Is the diagnosis and prescription obvious from the documentation you have to turn in?
posted by davy at 7:10 PM on June 26, 2007

(Maybe I should point out that I know very few people who don't have "mental-health issues" of one kind or another, so my perspective might be skewed.)
posted by davy at 7:16 PM on June 26, 2007

I too find it suspicious that you have to submit them to HR. I've always submitted my receipts for my Flexible Spending Account (that is what you're talking about, right?) directly to the FSA provider.

It's highly doubtful that your company actually handles the FSAs itself -- they almost certainly use some outside agency to actually handle them.

Did you get a card, website address, or any other kind of information when you signed up for the FSA, that would give you an idea of what company it's with? If not, I'd go to your HR person and try to find out.

There's no reason why anyone inside your company needs to see your medical receipts -- it should go directly to the FSA management company and to nobody else.
posted by Kadin2048 at 7:17 PM on June 26, 2007

Speaking as a person with a mentally ill relative, your only real hope of privacy is to pay these bills yourself, in cash or equivalent. No checks, no debit card charges, no credit cards. Cash and money orders. Your pharmacy records may have limited privacy guarantees under typical pharmacy disclosure notices, unless you take further steps to obfuscate them. If you're taking certian psychotropic meds, tracked under dispensing protocols, such as some atypical anti-psychotics, you're probably in a number of tracking and dispensing databases under your personally identifiable information. If DOJ had a reason to want to know, they probably could. The ACLU is not happy about this.
posted by paulsc at 7:19 PM on June 26, 2007

I used to handle FSA reimbursements for a small company I worked for. It's not terribly common for companies to do it themselves (and in fact we gave it up after we grew larger and it became a bigger pain) but it's not necessarily suspicious that you're submitting to your payroll department. But yes, do check beforehand to make sure that is actually the procedure, as there's a fair chance your receipts should go to a third party who handles that stuff.

In any case, payroll people are privy to all kinds of sensitive information; maintaining confidentiality is an essential part of the job. If you're aware of your payroll department divulging information they shouldn't, or if the records won't be stored in a locked file cabinet, then you'd definitely have reason for concern. With a large firm, and a payroll department that doesn't know you, I'd guess that you're probably forgotten before they even finish adding up the receipts (although that may depend on how exotic/weird/interesting your particular illness is).

So, I will say that it can be done with discretion and with minimal exposure of your information. Whether or not you trust your particular employer to do that is something for you to judge.
posted by stefanie at 8:25 PM on June 26, 2007

Agreeing with PaulSC. After I left my last job, I didn't do the COBRA thing, and I had to get BCBS coverage. There were a number of questions about mental health issues on there, which, if they were in any kind of medical records, could be summoned by BCBS for their underwriting review. Similarly, life insurance underwriting also requests your medical records and will see mental health issues.

Problem being that any future health insurance you need to apply for, outside of group insurance, is going to underwrite you and could do one of many things in regard to mental health issues:

1. Deny the coverage making it extremely difficult for you to find health coverage;
2. Raise your premiums a lot to cover any possible mental expenses;
3. Exclude any mental health coverage from your policy.

I most certainly don't want to discourage anyone from getting mental health care -- this is an unfair system, by all accounts. But nonetheless, you do need to be aware that this is the kind of thing that can, and probably will, effect you in the future. As Paul said, really the only way to avoid any of this is to pay for it yourself. I don't know if I'd be too worried about the method of payment (a health insurance company can't ask for your credit card receipts), but the more you cover your tracks to prepare yourself for future underwriting, the better off you'll be.

As far as where you submit claims to: your company shouldn't have access to ANY of your medical records. It's a conflict of interest.
posted by PandemicSoul at 9:58 PM on June 26, 2007

As stated, this shouldn't be going through HR. If it is, though, the information is still covered under HIPAA (HR is acting as a processor of personal health information). Any disclosure by the HR staff of these issues would be ample lawsuit fodder.
posted by bfranklin at 4:59 AM on June 27, 2007

Black out any descriptions of the medications leaving the dollar amounts visible on photocopies you give to the employer. Submit unaltered copies directly to the FSA provider.

Doesn't matter how "nice" or "professional" the HR folks are; they have no right or need to know.
posted by yesster at 5:00 AM on June 27, 2007

Exclude any mental health coverage from your policy

This kind of discriminatory bullshit could soon become illegal. There's a bill, HR 1424 ("The Paul Wellstone Mental Health and Addiction Equity Act of 2007"), currently gathering support to constrain the ability of insurers to discriminate against mental health and psychiatric reimbursements. Contacting your local congressperson (by telephone or letter !) would be A Good Thing.
posted by meehawl at 6:53 AM on June 27, 2007 [1 favorite]

If you work for a large law firm, there's a good chance you're not the only person submitting these types of receipts. I suspect, however, if you work at a large law firm, someone other than the firm is actually handling the FSA.

With respect to life insurance and future coverage, while paying your bills in cash might mean that there's no insurance record, there's still a medical record at the doctor's office, and failing to tell your insurance companies about your visits is not a good idea. In that respect, it doesn't matter if you get reimbursement from your firm or not.

All employees at law firms deal with things that need to be confidential all day long. If you really are supposed to go through your HR department, the person is probably capable of handling the information properly. And, you should only need to turn in receipts, not anything that diagnoses what is wrong. It's unlikely that Sally in HR is going to get much mileage out of "anon went to AnwhereUSA's Mental Health place." If you're married or have kids, they won't even know that it was you!

Please don't stress out too much about this. If you really are uncomfortable, go talk to your office manager/benefits manager and talk to them -- they should be able to reassure you, and they should take confidentiality very seriously.
posted by dpx.mfx at 7:15 AM on June 27, 2007

Seriously? Submit the receipts. You can still get life insurance. I disclosed mental illness when applying for life insurance and they pulled the records from my shrink and approved me. Hell, it's not like they're going to pay out if I off myself anyway.

If you think that you'll always have group health insurance (or in my case, I'll move to Canada if I'm in a position where I don't have group health insurance) then all the more reason to submit, submit, submit. Don't waste money.

Hopefully the receipts are routed through a third party.
posted by crazycanuck at 9:14 AM on June 27, 2007