When You Don't Know Where to Turn / A Self-Diagnosing Guide to Counseling and Therapy

by Steven J. Bartlett

If a patient is seriously suicidal—that is, has decided on a means to commit suicide, has decided when to do this, and cannot be persuaded to hold off while in therapy—the therapist is legally bound to take whatever action may be necessary to prevent the patient's suicide, including the disclosure of pertinent information to public officials.

Similarly, in cases of child abuse or neglect, the law requires that a client's confidential relationship with his or her therapist be set to one side in order to provide adequate protection and care for the child.

THREATS TO PRIVACY FROM
HEALTH INSURANCE COMPANIES

There is another way that privacy can be invaded, and for many people it is little known and more significant than the breaks of confidentiality we have already discussed. It comes about as a result of recently formed data banks that are maintained and continuously updated by insurance companies. Information about insurance claims and payments not only are kept on file by individual insurance companies, but a number of national data banks have been established to provide insurance companies with information about the health histories of individuals.

For example, if you file a health insurance application or a claim for benefits with many insurance companies, they often will run a check on your health history through a national computerized clearinghouse that maintains insurance information. This information includes data about previous insurance claims you may have made. Insurance companies believe that they have a right to data of this kind, since the information protects them from having to pay for health care costs that come about due to "preexisting conditions," which many insurance policies limit or exclude. Too, if you have suffered from poor health in the past, and were covered by insurance, there are probably data about your health history on file in such a national computerized clearinghouse; by accessing information about you, an insurance company is able to form a judgment as to whether you are an excessive risk.

Like any information about you that has been compiled and is furnished without your consent, these data about your health history—maintained by agencies that service insurance companies—are subject to possible abuse. Information on file can and is used to protect the interests of subscribing insurance companies; your own interests may not be served in the process. Not only might you be denied future insurance benefits, but the information maintained about you is subject to whatever use the insurance clearinghouse believes is appropriate.

As yet, laws to secure a true measure of personal privacy have not been passed. This has been one of the goals of organizations like the American Civil Liberties Union.

There is a second insurance-related issue that has to do with confidentiality. If you have group health insurance through your employer, it will be necessary for your therapist to complete reports about you in order for you to receive benefits under your insurance plan. (I am assuming here that your insurance offers coverage for counseling, psychotherapy, or psychiatry.) The reports filed by your therapist with the group health insurance company are sometimes filed through your employer, and sometimes employers require their group health companies to provide them with information about health care supplied to their employees. In either way, the fact that you are in therapy and the general reasons for your need for therapy may come to the attention of your employer.

If your employer is a large company or organization, such information will probably be filed in your employer's business or insurance office and laid to rest; it will probably not come to the attention of individuals you actually deal with in your work. But it may. In a smaller company, there is a greater risk.