That depends on your insurance company.
I’m apparently in the minority of those who steadfastly refuse to have clinical discussions with an insurance representative recorded. Perhaps my aversion is attributable to having been a lawyer or, more likely, to my commitment to protecting patient confidentiality. In an era where so much of what we want kept private is accessible, I will not allow what transpires in my office discussed with an insurance ”peer reviewer” and recorded “for quality purposes only”. While I am all for health Insurance companies implementing quality assurance measures — after all, they do seem to be lacking — not at the expense of my patients’ privacy.
Why is this happening?
More insurance companies are circumventing Parity laws by claiming mental health related treatment is not medically necessary. The Parity Laws require that the behavioral health coverage be no more restrictive than medical or surgical coverage in quantitative treatment limitations (limitations on frequency of treatment, number of visits, etc.) or in non-quantitative treatment limitations: including utilization review and “fail first” requirements. But, unless insurance companies question primary care physicians on 80% of their patients receiving treatment as to whether or not such treatment was “medically necessary” as they are doing with mental health providers, there is a systematic lack of compliance with the Parity Laws. Guess what happens next? Your mental health care provider receives a call to discuss your treatment with a “peer reviewer” and when that “peer reviewer” calls, the first thing he or she says is “I must inform you that this call is being recorded for quality purposes.” If your mental health provider does not refuse to provide clinical information on recorded lines, chances are some of those private details that you thought would never leave the sanctity of your clinician’s office, are recorded, being reviewed by whom, I certainly don’t know. What I do know is that the first thing I respond with in one of these reviews is “I do not provide clinical information on a recorded line; please call me back on a line that is not recorded.”
My first experience with a “peer reviewer” was several years ago and his response to my request is how I, naively, imagined any physician would respond. He said, “Of course, I will call you back from another phone. Frankly you are the first person to request that we not discuss clinical information on a recorded line and I just don’t understand that. I would never let someone record a conversation about one of my patients.” And so, the review took place on an unrecorded line with a psychiatrist that understood the importance of confidentiality.
Subsequent “peer reviewers” have not shared my commitment to confidentiality. A few times, due to my refusal to be recorded while sharing confidential clinical information about my patient, I have been told by my “peer” that he or she did not have access to an unrecorded line. When scheduling these reviews, in my naive hope that the peer review call will come from an unrecorded line, I specify, in advance, that I will not discuss clinical information on a recorded line. However, thus far, this request has not worked.
My patients have been penalized by my refusal to argue medical necessity on a recorded line. And, of course, this means I spend many hours appealing denials which invariably occur when I refuse to engage in a recorded call. But, to me, maintaining my patients’ confidentiality is worth the effort. Besides, one “peer reviewer” who did call me on an unrecorded line, indicated that the only way one patient could continue having her twice weekly psychotherapy covered would be if she were a danger to herself or others or would need to be inpatient as a result of the reduction in frequency. Basically, if, in the end the reduction in frequency would cost the insurance company more money than twice weekly psychotherapy, they will deem it medically necessary. Now, THAT part of the conversation, I wish I had recorded.
