About Private Pay
Confidentiality
private pay
insurance
There are two basic ways to pay for psychotherapy services:
- Private pay
- Insurance
There are pros and cons to each, and it’s important for you to understand how the advantages and disadvantages of each might affect you and the limits of confidentiality.
Confidentiality
The premise of confidentiality basically means that the contents of your conversation with your clinician will not be shared with others. There are some exceptions to this rule. While those exceptions change slightly from jurisdiction to jurisdiction, the conditions remain roughly the same.There are usually only a few reasons why confidentiality can be legally and ethically breached.
- It may be necessary to share some information with others involved in your care or to facilitate billing matters. This is the point that often becomes most relevant in making your choice between private pay and using insurance.
- If you reveal knowledge of or involvement in certain types of felonies, your clinician may be legally bound to report this to the proper authorities.
- If you reveal knowledge of the possible abuse of a minor or a senior, this must be reported to the proper authorities.
- In some jurisdictions, if the clinician has cause to believe that you pose a serious threat to another, the clinician may have to notify that person and/or the authorities.
- If the clinician is subpoenaed by a court, they may have to breach confidentiality.
However, there are steps we typically take to prevent this. For instance, we may ask you for permission to share the requested information. We may contact the issuer and determine if there is a way to provide the requested information without breaching confidentiality. If that does not work, we can make attempts to quash the subpoena. If that is not successful, then we can appear in court and invoke your privilege on your behalf. This means that we have privileged communication, and others don’t typically have the right to know the contents of that communication. If the judge still persists with the order, then the clinician must choose between breaching confidentiality and facing contempt of court charges.
Using Insurance
You purchased insurance because it is often a less expensive way to address your medical or mental health expenses.
The insurance company sets standards that providers must follow, or we don’t get paid. This is for your protection and theirs. Part of how they ensure you are receiving proper service is to demand certain information from the provider.
Since the insurance company is paying for your services, they have the right to know your diagnosis, what treatments your clinician is applying, the treatment plan, and your progress relating to that treatment plan.
They typically do not have the right to detailed information, including session notes and raw testing data. But they do have the right to the initial report – including your diagnosis and the results of any testing included in that report.
The bottom line is that if you use insurance to pay for psychological services, the insurance company has the right to certain information about the services they are paying for. Therefore, your diagnosis and the results of any psychological testing must be revealed to them upon their demand.
So, if you want to keep your diagnosis and/ortest results private, you may want to consider this in making your decision about how topay for services.
Paying privately
You have the option to pay out of pocket for psychological services. This means that you would not use insurance or any third-party payor. When you pay this way, no insurance company is paying for any part of your psychological services, so they do not typically have the right to any information regarding those services. By paying privately, you strengthen your right to decide who has access to your health records and the information contained within them.
Please understand that none of the information contained in this document is to be considered legal advice. You should also understand that what was said above is generally true, but may change slightly depending on specific jurisdictions and circumstances. This practice recommends that you seek the advice of an attorney for any legal matters.