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Mark Dombeck, Ph.D.Mark Dombeck, Ph.D.
Essays and Blogs Concerning Mental and Emotional Health

Clinical Privacy and Insurance Application Rejection

Mark Dombeck, Ph.D. Updated: Jun 10th 2002

Imagine, if you will, the following scenario:

Being of reasonably sound mind and body, you seek the help of a psychotherapist during a period of life-crisis (divorce, death of a parent or spouse, unemployment, etc.). During your first meeting, your therapist asks you how you intend to pay for her services. You respond by pulling out the insurance card you received from your employer. You sign papers authorizing the insurance company to have access to your therapy records and arrangements are made. Your therapist recognizes that she has to officially diagnose you if she is to obtain reimbursement for her services. She selects a DSM code that more or less makes sense for your current situation: "Adjustment Disorder with depressed mood" and goes on about her business of helping you. After a number of sessions, you find that you are in a better mental and emotional place and you terminate therapy.

A few years go by...

Things have changed in your life. Most notably, you are no longer employed. Perhaps you've been laid off from your former workplace. Perhaps you are in the process of starting a business. Perhaps you are staying home to care for a child you've recently adopted. You decide to apply for a variety of insurances that will help you to manage the risks inherent in life (health, life, disability). A few weeks after filling out your applications, you receive a reply from the insurance company that goes something like, "Dear So-and-so. Upon review of your application we are sorry to report that we cannot insure you at this time". A rejection? What's that all about? You call them up and find that they have rejected your application for certain insurances because of your past history of mental illness.

Outrageous, right? Nope. This is more our less how our insurance system works.

The chain of events that has led up to your insurance rejection went something like this. All those years ago when you were in therapy, your diagnosis was sent back to the insurance company that was paying for your therapy. They, in turn, sent it out to an institution known as MIB (short for 'Medical Information Bureau', not 'Men In Black'). MIB is a not-for-profit data warehouse sponsored by major insurance carriers. MIB's purpose is to record, retain and share personal medical information collected about you by one insurance company with other insurance companies. As part of the standard process of reviewing your application for insurance coverage, the insurance company called up MIB and took a look at your record. Noting the 'mental illness' diagnosis there, they decided that it was not in their interests to offer you insurance because of your previous diagnosis. Their reasoning would be something like, "This person may very well get depressed again in the future, possibly even depressed enough so that you require treatment or become disabled. We'd have to pay for that treatment. There is, therefore, too much risk involved in insuring this person".

From a purely business point of view, we can certainly understand why an insurance company would want to consult information about your past when making a decision as to whether to insure you. Insurance companies make money when they pay out fewer benefits than they have collected in premiums. It is in their interests to have as many healthy customers and as few service-using customers as possible. But viewing this issue solely from a business vantage obscures the fact that serious ethical issues are in play; people's lives are at stake when they cannot get reasonably easy access to healthcare. And, even as it is true that someone with a past history of depression is much more likely to require treatment for depression in the future than someone who has never been depressed before, it is also true that a person with a past history of depression has a greater need for depression coverage than someone who is unlikely to become depressed.

You may wonder why I made it a point in my example above to specify that you were unemployed or self-employed when you made your application for health and disability insurances. This is because the insurance you can by as an individual has different standards applied to it than the insurance that you can receive through a company-sponsored insurance plan. Individual insurance applications are checked against MIB and similar institutional records to see if you are likely to end up costing more than you will pay out. Company-provided 'group' insurance applications, on the other hand, are not checked against MIB records; so long as you are an employee of a medium to large firm (at least in the USA), you are able to get insurance coverage. I'm not entirely certain why this is so, but I believe the idea in play here has to do with whether your candidacy for insurance coverage is examined individually, or against the backdrop of a large group of fellow employees. In the company provided insurance situation, where there are large numbers of fellow employees to offset the risk you may contribute to the total pool, there are bound to be more healthy employees paying into the system than ill ones. In the individual situation there is no one else about to help the insurance company spread out their risk and it becomes a crap-shoot as to whether the insurance company will make or lose money. I don't know what the originators of this differential-evaluation practice intended or how the system evolved to be this way. I do know that the end-result appears to be that only healthier, higher functioning employed people will have easy access to insurance, leaving those people with greater needs for healthcare at the mercy of under funded and overloaded public health systems.

 


MIB rationalizes its existence by suggesting that they function as a sort of police agency that tickets anti-social insurance applicants who would try to gain access to insurance by not disclosing their checkered pasts, as is evident in this quote taken from the MIB website.

 

"You're driving on the highway and there's a "Road Construction Ahead" sign indicating you should merge to the left. You responsibly start moving over but several "fudgers" ignore the signs and keep on roaring ahead in the right lane. Some real jerks even have the nerve to continue to pass driving on the shoulder of the road, just to get a few more car lengths ahead, counting on the fact that some sympathetic party will let them back in line at the last second. Are these compliant people who let them in naïve enough to believe that these poor people were too stupid to have realized that the signs were intended for them too? Or are these "fudgers" simply taking advantage of predictable human nature?"

"As a responsible person who followed the law, all you're left with is a little sense of frustration and semi-outrage and wishful thinking that there's a policeman somewhere who is positioned up front to ticket those whom they catch in the act – especially those driving on the shoulder."

"Unfortunately, in life, there are also some individuals who seem to believe that people who are forthright and honest, when they apply for life, health, disability, and long term care insurance, are "suckers". They somehow rationalize that stretching the truth or omitting relevant medical history or other pertinent information on an insurance application is the company's problem, not theirs. Were there not safeguards in place, honest and responsible insurance applicants would be paying substantially more for their life, disability, and long term care insurance premiums. . . in fact. . .subsidizing those who should be paying more."

 

In the above quote, MIB appeals to your rational business-minded side. They are suggesting that the service they provide helps keep your insurance rates down by making it easier for insurance companies to discriminate against greedy high-service-utilizing applicants. But there is probably more to you than simply a business-minded side. I'll bet you see through this rhetoric enough to know that there is something decidedly unspiritual and fundamentally anti-social in the act of denying the truly and legitimately needy access to health services they require.

While it is completely true that some insurance applicants do actively seek to defraud insurance companies, it seems quite misleading of MIB to encourage you to assume that all persons who might want to keep their past medical records private so as not to be discriminated against are sociopaths and cheaters. Is it really anti-social behavior for someone with a history of mild depression (or even serious depression) to want to keep their medical record private when their access to healthcare and disability insurance would be cut off if a prospective insurer were to see that record? It may well be anti-social behavior from a libertarian or ayn-randian point of view, but from a more moderate stance, it ends up seeming only desperate and human.

 


I've wondered for some time why there is seemingly no easily accessible way to pool together large groups of the uninsured (and in some cases uninsurable) for precisely the purpose of providing them with a way to purchase reasonable health or disability insurance. Unless only legal forces force insurance companies to not reject insurance applications made through company-sponsored programs, surely the same pooling of risk that occurs in a company plan could exist through other means of grouping applicants. Why does the vulnerable individual have to pay such a high price for not being employed? The answer that comes to mind is, 'politics'. I suppose that it is simply not in the collective interests of those in power to provide this sort of access to care.

 


Your options for dealing with this situation aren't extensive. The health care system is a mess and even the well-insured have difficulty navigating it these days. Health care of all sorts is also very expensive. If you become really sick at any point in your life, requiring extensive care, you'll have little choice but to trade your medical privacy and future individual insurability for access to treatment. Although future access to insurance is important, it isn't worth jeopardizing your present-day health or quality of life over by forgoing treatment.

At the individual level, if you have the means, and if your problems are moderate in scope, you can do something about the situation: cut the insurance companies out of your personal healthcare loop by paying cash for your health treatments. For example, one might pay cash for psychotherapy. There are today a growing number of psychotherapists who, for a variety of reasons that include frustration with paperwork and ethical upset over not being able to protect their patient's confidentiality, no longer will accept insurance as a means of payment for their services. There are positive direct benefits for patients to work with therapists on a cash-only basis: Paying cash for treatment makes therapy a straightforward transaction between yourself and your therapist and removes the need for your therapist to diagnose you, or to report anything about you to any sort of third party. Since doctor-patient communication is protected under most state laws, it would take a court order to have your records revealed to anyone. The MIB need never know anything about your treatment. There are also positive side effects that come from paying cash for treatment, perhaps most importantly the fact that you tend to become very motivated to get your money's worth out of the treatment in a way that might not have occurred if someone else were paying most of your way.

Real though the privacy and motivation benefits may be, we must acknowledge that cash-for-treatment arrangements are at best only a partial solution to the problem of healthcare privacy. Cash payments can only be made by comparatively wealthy patients, and is not practical at all when expensive treatments are involved. It is also fairly useless when medicines or other treatments that require (by law) that third (record-keeping) parties (e.g., pharmacists) be involved. Aside from a few not-for-profit organizations, like Hartford, Connecticut’s Volunteers in Psychotherapy (which offers no-cost psychotherapy to patients willing to do community volunteer work), the unemployed and more vulnerable members of society are out of luck.

Well, I don't have any real suggestions as to how to solve this problem. But I bet some of you readers might have a suggestion or opinion to share. Feel free to comment on this editorial by clicking on our new 'add comment' feature that appears at the bottom of this page. And take a few minutes to explore MIB's website which is available at www.mib.com. Until next time.

Mark Dombeck, Ph.D.
Director, MHN

 

Mark Dombeck, Ph.D.

Mark Dombeck, Ph.D. was Director of Mental Help Net from 1999 to 2011. Presently, he is an Oakland Psychologist (Lic#PSY25695) in private practice offering evidence-based acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) and addressing a range of life problems. Contact Dr. Dombeck by calling 510-900-5123, send Dr. Dombeck email or visit Dr. Dombeck's practice website for more information.

    Reader Comments
    Discuss this issue below or in our forums.

    Thank you for trut! - GB - Jul 25th 2011

    If you admit you live with a smoker and have asthma or if you ever smoked you will be denied private health insurance. 

    I had family members die in a car wreck.  I was self-insured and paid cash for therapy sessions to deal with the trama.  I knew if I tried to apply it to my horrible private health ins. premium of $7,500.--deductible,  I would have a black halo over me forever.  Insurance Co's. suck. 

     A vet. asked me for my S.S. number when I paid cash for my puppy and I said go to hell.--p.s. I did not have health insurance on the dog.

    knowledge defeats fear - lee du ploy - Nov 29th 2010

    Since my last  last post here, I have been looking at various options whch may eleviate the  trauma of minor medical conditions, and the assumed fear we foist on ourselves through this assumption.

    It may help you to know that the fear of falling ill by  far outweihgs the actual event of the situation, many patients I speak to are relieved to find the actual event of a minor illness less traumatic than the fear and anticipation of it.

    Try to objective and do not let fear control your emotional reaction.

    We spend years anticipating a problem (one which may never even happen ) and worry so much that it prematurely makes us ill.

     

    lee du ploy ( hong kong )

    health insurance - - Sep 21st 2010

    I'm bipolar and I have a host of other medical problems. I live on my husband's disability check of 1,200 a month. He gets health insurance. We have to pay for mine. It costs 350 a month. I figure that's $10 a day. I save it up by cutting out latte's, McDonald's, the morning newspaper, and I buy most of  my clothes second-hand. When you really need it, you find a way. You just have to. It isn't easy.

    Medical help abroad - lee du ploy - Nov 14th 2009

     

    In case you (miss) read my caption it has nothing to do with being treated by a beautifull nurse in South America.

    However it appears that we are on the point of an tamultious change regarding the approach to heatlh service in the USA,not quite there but potentially possible.

    In the interim if you are suffering from something which worries you unduly and its making your life miserable with worry...........take a little time , be objctive and considdder an option of having medical treatment abroad.

    Check "tips for travelling abroad"  on Google it contains a wealth of helpfull hints,infact virtually all you will need is encapsulated there within( sorry too English) should read 'everything you need is available there)

    Remember the biggest fear about the unknown is the the fear about not knowing( as para phrased by many) as in "fear of fear."............but I urge  to considder this option if its something that worries you unduly.

    The solution is on your doorstep.

     

    lee du ploy( hong kong)

    banned for individual health insurance - - Oct 30th 2009

    Wow, I am shocked that I coiuld be turned down for health insurance because I take anti-depressants.It was my choice to be on antidepressants due to some fianancial issues going on in my life loss of job.  I should have been told that if I go on this medication that I will be banned for individual health insurance.  I am 58 years old and have no other health issues, except allergies.  I take an over the counter drug for that.  If ever there was something not fair, this is it.  I feel that this is wrong.  Why cant they insure me and just exclude anything resulting from mental illness.  I would sign papers to that effect.  I would not mind that at all.  I have been on antidepressants off and on since my first divorce in 1986.I was just told by an insurance agent that I could be turned down due to my depression.I would like to know who isent depressed in this society today.  Just about everyone I know is on antidepressant or has been on it sometime in the past.  None of this makes sense.  I think we should get busy and do something about it.  I dont know what to do however, except to look for employment that has medical benefits.  I am self employed and I dont know what I am to do now. Looks like since I am a business owner that should give me some advantage. 

    We all better do something.  I cant believe this has been going on all these years.. Why has it been a secret.

    We can atleast get the word out.

    Insurance companies have the advantage over us.

    It seems like  I keep coming up short no matter what I do. 

    can your insurance premuims be better spent - lee du ploy - Sep 28th 2009

    There is a school of thought, which seems to prevail more and more, that insurance of any kind is simply a waste of time and money.

    Considder for a moment how much money is spend and how much is claimed.I am not suggesting that one should simply claim because you pay,but it would be interesting to know the correlation between this dilemma.

    In addition how many  false claims are made and how many legit claimants are assumed to be making false claims.

    My contention is that unless one is forced to insure,then do only the basics,obviously there are some policies over which we have no control and I wont tax your intelligence here discussing them but there is so much anxiety and stress caused by assuming no insurance no treatment;I have found this not to be so.

    Make a modest saving each month and sellect through research where you want to spent your money, search around and find where your money is better spent,and sellect the treatment you want on the bassis of where you can get it.

    Travelling abroad is now normal for medical treatment and its much cheaper.

     

    I have worked in various countries and found that medical insurance is simply a metaphore for unncesarry worry.

    Minor medical  problems are very easilly resolved through not expensive alternatives, look and ye shal find.

     

    lee du ploy ( hong kong) china

    Less Serious Medical Issues Resolved Through Expediency - lee du ploy - Sep 26th 2009

    Medical training in any form is long,it takes tenacity and years of perseverance.The final stages are the most difficult and many "drop out" due to the presure of the profession.

    Its my conclusion that hours of "doctor time" is spent on paptients who could easilly be diagnosed by specially trained nurses or health care workers.

    The minor medical conditions such as hypertension,diabetes etc., once diagnosed seems to me that seeing a doctor again to confirm the prognosis is wasted.

    In some latin american countries and cuba medical missionaries(not religious) are trained to treat minor medical conditions thus releasing the doctors to specialize in what they  are trained in.

    I may not get your vote for my suggestion but immagine if your local hospital could have a "three tier" system where the minor,major and extreme cases could be dealt with by this system...............................In my opinion it would ease the burden considderable and cut patient waiting times in half.

    Lee du ploy

    I hope this information can help someone - Dr.T - Oct 30th 2008

    I just wanted to add that there is a program known by Highmark that only charges $35 per month (the premium) called AdultBasic and SpeicalCare. Contact highmark and ask about them. I was removed from my mothers insurance once I turned 21 as well. Now at 23 I am in search of my own insurance because I need it as a grad-student. My school would cost me an arm and a leg just to be covered. I also take medication and I really need coverage to save money. It's sad to come to grips with the fact that the richest country in the world charges you for health.

     

    Very sad.

    Mrs - Audrey C. Smith - Jun 27th 2008

    I agree with all of the above comments. Unfortunately, in our case, medicaid was great for us (under the United Healthcare plan) in Maryland, but then one of our daughters turned 21, and Social Services cancelled our medical. My husband is a recovering colon cancer patient. At the same time, or a little later on, I suffered with a hernia disc for 10 months. Pain was immensed, and United Healthcare would not pay for my operation. Thank God it went away with the pills they issued me, but it took a long time. In my husband's case, they covered all of his chemo and radiation treatment, as well as his medicine. Now that we don't have insurance through Social Services, the state insurance of Maryland (using PAC), and the United Healthcare plan, they are not covering for his recover treatments. We have two bills now, totalling over $600.00. Where do I go and get these bills paid when both of us don't have any work?

    I need someone to help us with giving us some tax deductible money to help pay these bills. We already have our gas and telephone services turned off (June 2008), and we are getting to the point where the electric will be turned off next. Insurance companies are a drag, and should be omitted from our USA system. We paid a lot of taxes and are close to retirement. I bet the money won't be there for us for that as well. Politicians have already used up the most of that to pay off their own debts. It is just not fair.

    Someone please respond to this. Thank you. 

     

     

    Private Pay Option - Nicole Laurent, MA in Clinical Psychology, Registere Counselor - Feb 24th 2008

    I am a private pay therapist who will if a client has a history of chronic mental illness, work with the billing specialist at the center where I work. But for the most part I only take private payment because of the issues talked about here and other issues that have not been fully dicussed. I do it to protect my clients from future difficulties and to focus on giving truly the best care possible. I take every type of credit card and I have created an interest free payment plan for clients. Because I am a cognitive behavioral therapist, I am able to provide an estimate for a course of therapy, and clients can pay off the balance over the course of 12 months, or longer in just a few circumstances. I am able to truly protect my client's confidentiality this way. Even if I were to ever have to send someone to collection, it would be necessary to divulge just a name and an amount, and there would be no diagnosis to haunt them as they try to secure insurance, employment, or in the case of children and teens, an sense of identity without the need for labels.

    I have put a link to this site from my practice website to help educate consumers of mental health services why private pay in our society at this time, is a truly viable option. I think the sharing of all your stories serves this very important purpose and has been such a gift to others making these hard decisions about self care.

    Child Denied Medical Benefits due to ADHD and Anxiety Disorders - - Dec 10th 2007

    My 11 year old son has ADHD and Generalized Anxiety Disorder. I went through a job change and insurance change. The new insurance through my company was outrageously priced and being a single parent I chose to apply for a personal plan through United Healthcare (underwritten by Golden Rule). They denied my son medical coverage due to his mental health issues, even though they do not cover mental health issues to begin with.

    Editor's Note:  Currently, in the United States, insurers can reject individuals applying for individual coverage for any number of reasons, subject to state law that might prevent that.  In some states they can't reject you but they can jack up your rates to accomplish the same.  Since you are employed, you should be eligable for group health insurance.  Insurance companies cannot deny you coverage for pre-existing conditions when purchased through a group plan (such as offered by many employers).  They can however, jack up the cost to your employer who, after a point, will pass on the cost to all employees by way of higher costs.  Though this is still not so great, at least you can get coverage via this mechanism.  

    How do I set Up pre-Diagnosis of bipolar(or similar) - - Jun 15th 2007

    After much research, my wife and I have a strong suspicion that I have bipolar disorder, or perhaps something similar.  I have heard your horror stories of dealing with the insurance companies, and many more like them.  I am searching for a Good insurance company that is not going to drop me as soon as I am diagnosed.  If Anyone has any tips or suggestions, PLEASE, help me understand what I can do to protect myself NOW!, before preexisting condition issues become a problem!!!!!!!

    Reasoning nonsense - - May 6th 2007

    "Look at it this way, if you are reasonably sure that your expenses won't exceed your premiums then just self-insure yourself. But, you know darn well your expenses will exceed your premium which is exactly why you're out there looking for insurance. In effect you are asking for a free-lunch. The corporation is saying, in effect, that the government is in the free-lunch busness--not us. I'm not so sure I see this as a problem."

    That is the most ridiculous argument I've heard. Insurance was not intended to be setup such that each and every person's premiums cost less than his/her medical expenses. If that were the case there'd be no point to insurance. The whole idea behind insurance is that the individuals who cost insurance companies less than their premiums do provide extra funds for those who cost more. There are plenty of people whose premiums cost more than they use every month so insurance companies have funds to use for higher-cost patients. The whole point of insurance is to prevent extreme financial hardship due to illness or accident. Profits aren't calculated on an individual premium vs. cost basis. The cost is shared by all those who pay into insurance but don't use it or use less than they pay for. To argue that you should not get insurance if you MIGHT cost more than your premiums says insurance has no purpose. And to imply someone is asking for a "free lunch" because they have a medical condition is also nonsense. What about all those years the individual may have paid insurance and never used it? Was that factored in? No, of course not. You could argue the insurance company was getting a "free lunch" from the individual (or their employer) all those years. I think it's absurd you can work 20 or 30 years, your employer paying who knows how many tens of thousands in insurance premiums all those years that you may never have used, then your first year unemployed you are denied as if one medical condiion is going to cost them more than all tens of thousands that you've already provided them. It's robbery.

     

    Good Insurance Companies - mel - Mar 9th 2007
    I have had issues with depression and on meds in the past and was able to get health insurance issued through Golden Rule (Private Healthcare Systems Network) and Assurant (Time Insurance - United Healthcare Network). They are very lenient especially if you have been off meds for over 1 year. Good Luck!

    Disability insurance for mental illness - - Feb 28th 2007
    I don't understand why they can't still insure you, but just have some limitation on certain pre-existing conditions (such as mental illness!), OR have a higher premium if you expect such condition to be paid out if needed.  I would expect that many would prefer the lower premium, and then if they become disabled due to their mental illness, the insurance company wouldn't be losing any money, but then at least we're covered for EVERYTHING ELSE that could happen to us!

    Not doing a whole lot of good... - - Jan 22nd 2007
    As someone who was uninsureable due to a dsm, I understand and sympathize. My DSM code was homosexuality. I currently have a partner who can't get coverage due to a gender identity disorder (what the APA replaced the homo dsm code with). there are rights being taken away CONSTANTLY, but no one seems to care until their rights get stepped on. I say the next hurtle is the APA (american psychiatric association). If they are going to have these diagnosis, they need to realize what goes w/ them when someone is looking for insurance. Write a letter to your congressman/mayor/senator/therapist...

    Denied my Company's benefits b/c of my bipolar diagnosis - Lori - Nov 7th 2006
    Hi. I just graduated from college and got a full time job. I was very happy to learn that my job offered good disability insurance. This meant a lot to me because my dad was diagnosed with MS when I was very young. As I grew up, his disability insurance was our family's only source of income, so I know that disability insurance is important and I fear that I could get the same disease. However, today I received a letter saying Guardian was declining my application. There was no explanation but I assume it is because I have been diagnose with bipolar. This insurance was supposed to be a policy that would be paid fully by my employer. Am I entitled to any coverage? How could they hire me saying that I would get this insurance as part of my beneifts and then I find out a couple months later when I am eligible to receive it that the company is declining me? Can anyone give me some info on what my rights are, please? I am not so worried about becoming disable by bipolar, but other things such as MS. Could they have figured my dad's illness and declined me because of that? I would appreciate any feedback. Thanks!

    Costly - MacDuckov - Jun 29th 2006
    I guess the question is why should a corporation take on someone who they KNOW they will lose money on. When insurance companies take a policy for an entire large company the company has more bargaining power and will not allow the insurance companies to screen each and every employee (they'd have a harder time hiring talented people). That is not the case when you are one person out there looking for insurance. Look at it this way, if you are reasonably sure that your expenses won't exceed your premiums then just self-insure yourself. But, you know darn well your expenses will exceed your premium which is exactly why you're out there looking for insurance. In effect you are asking for a free-lunch. The corporation is saying, in effect, that the government is in the free-lunch busness--not us. I'm not so sure I see this as a problem.

    What they don't tell you! - Flabbergasted - Oct 18th 2004
    I am a healthy 29 year old woman. I just applied for an individual health & dental care policy, fully expecting to get my acceptance and first bill when instead a REJECTION letter came in the mail! BlueCross BlueShield of Oregon denied me because of "History of or current depression". I had no idea they could do this! Certainly when my doctor prescribed medicine to help me deal with the death of my mother and father, I was never warned this could effect me later on. I'm pissed!

    Medical Editor - Mary - Nov 4th 2003
    I just got "rejected" by a COMPANY's life ins. company -- oh hell yes, they do check every single person, we are watched! I filled out a simple form for what I believed to be the Medical insurance, and not wanting to lie by saying nobody in my family ever took pills, I admitted we had been to see doctors outside of regular visits, and took medications. My husband has high blood pressure, me a history of depression controlled with a mild antidepressant. They asked for my entire medical history from my PCP, and not only that the PCP SENT IT. Please watch out for this!!! After having a car accident LAST YEAR, on a neurologist's form I said "history of bipolar" (said about me when I was screwed up by Prozac TEN YEARS AGO!!!) The company's company would not give me their lousy stinking life insurance policy because of this "record." The doctor whose form I filled in was a creep neurologist, not a psychiatrist, but that was an egregious error on my part, never ever thinking my primary would copy every sheet of ten years plus referral's comments and records. The PCP agreed I do not have bipolar myself, that I was diagnosed in error (in a hospital, they will diagnose anyone as crazy and give you thalidomide and a lobotomy.) I could not absolutely believe my ears. I really have to say, GUARDIAN LIFE, how anal can you be? This is so not fair it is ridiculous.

    Student - M.G. - Sep 24th 2002
    I have the unique vantage point of currently being a 2nd yr MSW student and a former Blue Cross/Blue Shield employee, as well as a mental health consumer. I left BCBS because of the grossly unethical stance they take toward this very issue. Rest assured that this happens not only to those seeking psychotherapy, but to those requiring certain medical services as well. You are right on, Dr. Dombeck, in your description of group policies and how they work, and I'd like to say thanks for informing those of us who have a great deal to lose, like me, who hopes to continue with my own therapy as well as be a provider soon myself. I'll be looking elsewhere besides BCBS for coverage.

    Just a suggestion - Keith - Aug 30th 2002
    I am a first year student Masters student in a Clinical-counseling psychology program. I would like to share my disgust over the way those who need health services are rejected by insurance carriers driven solely by the almighty dollar. However, there may be a way to solve the problem and avert health insurance providers at the same time. This answer lies in pro bono counseling services. While I am aware that many mental-health practitioners cannot offer free services and still make ends meet, there are surely many others who can. it is time for these more fortunate counselors to offer help to those who have no other means to obtain it.

    I've had this happen to me - Mary D. - Aug 25th 2002
    I was denied insurance becuase of migraine headaches, which I get about 1X/month. The insurance company refused to insure me b/c the medication was too expensive - $15/pill X 12= $180/yr. Unbelievable - it's all about money, but insurance is going to remain that way as long as stockholders and people profit from keeping costs down and denying people access to insurance.

    I don't understand the rational - Katherine Layman - Aug 15th 2002
    I am a 36 yr. old single mother of four. Also enrolled in school at University of Idaho College of Engineering. The first few years of college I relyed on pell grants and student loans. I also participate in the Vocational Rehabilitation program which unfortunatly will only pay for expenses that Pell grants wont cover. I overextended myself on student loans and decided to work for the university instead. I carried primary insurance through Blue Shield of Idaho and secondary insurance from Medicade. Only as long as I was employed. Frightened of the degree of debt I was getting into with my student loans I was forced to work full time. Single mother, 40 hrs a week, full time engineering school, 4 children, 2 dogs, 2 cats, and a mortgage. I was simply overwhelmed. I had a major break down and was forced to go on a layoff register for work. My grades slipped and to protect my position in engineering school I was also forced to take a medical withdrawl from school. I began receiving Long Term Disability from my employer insurance. Since that date I have had 3 admits to the Behavorial Health facility where I live. Only the first admit after the inital breakdown was paid for by insurance. Because of my $695.00 am month that I get on long term disability I no longer qualify for state medicade...I MAKE TO MUCH MONEY ON DISABILITY...no kidding. I now have about 50K in unpaid medical bills and have a $734 a month perscription bill and remember I make to much money!!!!!! where is the rational?

    What are the alternatives? - Jessica - Aug 12th 2002
    I am a 21 year old college graduate who has overcome a lot to become who I am. Due to predisposed genetics and a terrifying childhood, I will have to live with the label of mental illness for the rest of my life. Through a combanation of drugs and therapy, I am capable of living a healthy normal life, but without that (especially the drugs) I am a raving lunitic. I have been without insurance for about four months now, and in that time I have been admitted to the hospital twice spending, in all, four weeks in a very expensive bed. Since I am disabled, even though I desire to work, the government will eventually pay for those days and nights equaling tens of thousands of dollars that could have been better spent elsewhere if I had been capable of continuing my drug therapy. My point is that we WANT the mentally ill to have health insurance because that is the only way to get the preventative medicinen that will keep them out of the public assisted hospital, working, and in much better health and spirits for the rest of us to come in contact with. So pay for the prozac and lithium and the therapy sessions. Yes, it costs, but it is prevention for things and lifestyles that will cost our community much, much more.

    Found Insurance - Susan Danko - Aug 5th 2002
    Being self-employed I too was denied insurance because of depression. I was able to find insurance with a company that was fairly reasonable. It's worth checking out. www.goldenrule.com. Good luck to all of you depressed self-employed people.

    Thank You - Allison - Aug 2nd 2002
    Dear Dr. Dombeck, I wish to thank you Dr. Dombeck for your insightful and frank commentary on the unjust health insurance companies. It is helpful to hear it from a professional's perspective. My husband and I are both out of work right now and collecting disability. Both of our mental health diagnoses have been a cause for concern in terms of future coverage, yet, we currently have to fight for every visit we have with our psychiatrist/psychotherapist. Unfortunately, ethics do not concern the insurance companies - money does. Still fightin' Allison

    As a therapist... - Merilyn Hand - Jul 29th 2002
    As a therapist I have watched the taking over of the profession by the state/business coalition. Here in Hawaii it is devastated by huge bureaucracies and governed by manuals that are like military procurement docoments. As a private practitioner, I use a sliding scale, fee for service model...the only way to assure confidentiality and client respnsibility for their therapy. Until we get past this chaotic mess, there is no other option if I am to maintain my integrity and ethics.

    Until there's a solution...cash only! - Dennis Di Donato - Jul 26th 2002
    After experiencing the problem personally...seeing a therapist during a period of transition and then being denied insurance as a self-employed individual and then with a young, perfectly healthy 22 year old intern, who's only problem was telling the truth about voluntarily attending substance abuse groups as an undergrad due to being a child of alcoholics...I've decided not to accept insurance for my private practice clients. I generally advise them about the MIB and the risk's they face should they need to find insurance as individuals. Even COBRAS are not safe because the insurance companies can raise the premium's to astronomical rates that an unemployed person could never afford. (The Kennedy-Kassenbaum Bill protected "portability" but not premiums.) The only real solution to our health care delivery system is a government, single payer system or legislation eliminating MIB and demanding full, affordable insurance for all Americans from the private insurance companies. Until then, we should be encouraging private practitioners to have these conversations with their clients prior to accepting insurance as a means of payment.

    Health CARE? No way! - Kay Christian - Jul 25th 2002
    They took the Hippocratic Oath they call themselves health CARE providers. The truth of the matter is that they only CARE if you have money or insurance. They don't give a rip if you live or die if they dont make that money. My 34 year old son was just diag. with Hep C. He went to give blood a noble jesture. They didnt ask him if he had money or insurance when he went to help. I have tried to get him into 6 doctors, not one will treat him. So don't tell me that they CARE----- The entire profession is about PROFIT not about PEOPLE. I am an ex military nurse, I almost gave my life helping people, and the doctors today are worried about money........please. Socialized medicine is not perfect, but its a hell of a lot better that what we have. Thanks I feel better.

    rejected for health insurance - - Jul 25th 2002
    My 9-year old son is "gifted". Very smart but sometimes emotionally immature. very sweet, never violent. Took him to a child psychologist for six sessions to help him out, nothing serious. Started a new business with my husband, applied for health insurance with the same managed care company that previously provided me with group coverage before starting our own business. We were outright rejected. Seems the psychologist our son went to submitted claims with the diagnosis "Oppositional Defiance Disorder" which my son does NOT HAVE. The psychologist even admitted that! He just needed a diagnosis for "billing purposes". My son is happy and healthy. I thought I was doing the right thing getting him counseling and now we can't get health insurance!!! I would have paid cash had I known!

    Not just mental health - Margo - Jul 24th 2002
    My husband and I were denied health insurance when self-employed because of our weight (though we have no great history of claims, we're both extremely healthy). However, our State, Maryland, requires insurance companies providing health insurance in the State to have a couple open seasons and take all comers. We got Blue Cross/Blue Shield coverage, albeit at an extremely expensive rate. I think states should step in and monitor the insurance carriers in their states, arbitrating between their citizens and the insurance business. There are automobile laws covering auto insurance, why not health insurance?

    Where are the mental health advocates when the government votes on issues? - Teresa - Jul 12th 2002
    I myself am struggling with severe depression and though I am using my dad's insurance, still being in college and only 20 years old, I want to strike out on my own and get my own insurance. I feel held back from that because of how much the cost is and the likelihood of a company denying me the insurance I need. I'm fortunate to have a therapist taking me Pro Bono right now, but I've been in the hospital for other serious medical problems and can't help but think about what is going to happen to me when I have to get my own insurance and, failing to do so, then end up in the hospital with a huge bill to pay on my own. Why is it that companies would disregard the lives of people who struggle with every day stressors already? I think more should be done for those with mental health problems, and though lacking a solution to the problem at the moment, I think if the government can step in and provide welfare and things like that, something can be done for people mental health problems.

    It happened to me - Keri, a LPC in Texas - Jul 3rd 2002
    At age 30 (10 years ago) I was declined health insurance through my small employer because I had received counseling for mild depression. At the time, I was in graduate school for a counseling psychology degree, where we were encouraged to seek and experience counseling as needed as part of our professional development. I was in excellent physical health and wished the insurance companies would look at the benefits of counseling in light of the whole mind/body/spirit connection. Research continues to show that a high percentage of doctor visits are stress/mental health related. One can argue that since counseling contributes to mental health, it can result in a reduction of payment for many other medical doctor visits, tests, etc.

    Create a Government Health Care System for all. - Darleen W. - Jun 23rd 2002
    I am one who has had multiple medical problems(which includes mental health,) added to my health history. It has been costly for both myself, husband, as well as the insurance companies. I can not help it and I didn't chose to be ill. I would rather not take medications, or treatments, but I have to in order to maintain control of my well being. I have had depression (severe) for many years. I need, as well as many others, health insurance which won't break us. I understand that the medical professionals would have to take cuts in wages if the government was to create a program where it receives the monies to produce a health insurance all can afford. However, something has to be done to help the less fortunate. The "It's not my problem," attitude is cruel. Everyone could get the help needed and not be turned down or limited. I know it's not that easy, but something needs to be started. It's just not right the way the current system is going. Maybe I'm looking at this through rose color glasses. I just feel that the health of the people should be a priority. Maybe it would reduce expenditures in other areas.

    Does the same thing happen in Canada? - Anne - Jun 20th 2002
    As I was reading this, I was reminded of a situation, similar to what you're describing. I had a kind T who would only allow me to pay $10 per session because the psychology group to which she belonged said she had to take payment of some kind and since I was out of insurance and she wouldn't see me go without therapy, she said $10. In reading this document, I get the impression that the professionals really do care. Maybe if the ones being treated feel so cared about, it may lessen the stress and an answer to the problem of insurance or lack of, may come about.

    Frustrated Parent - Karen Hagan - Jun 16th 2002
    I have a 22 year old daughter diagnosed years ago with Bipolar disorder.When she finished a 1 year college certificate program,her insurance ran out.She was under her father's policy and to put her back on the policy it was going to cost her(or us) about $400 a month.She has applied for Mass Health but the process is so slow and we are waiting to hear if she is accepted.Meanwhile she has difficulty holding a job or maintaining friendships.She is difficult to live with and is in serious turmoil. We pray that Mass Health will come through for her so that she can get the help she so desperately needs.

    The basic problem - Mike S. - Jun 15th 2002
    What health insurance companys are are BOOKIES. You're gambling you'll need it, they gamble you won't. That's why the entire CONCEPT of health INSURANCE has to be done away with. If you need it to live, you have a RIGHT to it! This is what GOVERNMENTS are supposed to provide!

    Finding Insurance - - Jun 11th 2002
    This is a huge dilemma that I am facing right now--trying to find health insurance after being treated for depression. My husband has had a group policy at work that previously covered us. But now he is out on his own, and we find ourselves searching for coverage as individuals or for my small business of two people and simply seem to be coming up against a brick wall. Are there any alternatives?

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