Under federal law, insurance companies are only entitled to access the minimum necessary information to process a claim; however, insurers have been known to inappropriately request private information to process claims for mental health care.
Legislation (A-3955) that would directly address this problem by prohibiting mental health care professionals from disclosing certain patient information to an insurance carrier was approved Thursday by the Assembly Human Services Committee. The bill is sponsored by Assembly Democrats
"There's no reason for insurance companies to need information disclosed in private therapy sessions in order to process a claim," said Vainieri Huttle (D-
Under the bill, a mental health care professional would be prohibiting from disclosing a patient's information to an insurance company except for the following:
- The patient's name, age, sex, address, educational status, identifying number within the insurance program, date of onset of difficulty, date of initial consultation, dates of sessions, whether the sessions are individual or group sessions, and fees;
- Diagnostic information, defined as therapeutic characterizations of the type found in the current version of the Diagnostic and Statistical Manual of Mental Disorders or in another professionally recognized diagnostic manual;
- Status of the patient as voluntary or involuntary; inpatient or outpatient;
- The reason for continuing behavioral health care services, limited to an assessment of the client's current level of functioning and level of distress. These aspects shall be described as "none," or by the terms "mild," "moderate," "severe" or "extreme;" and
- Prognosis, limited to an estimate of the minimal time during which treatment might continue.
"When a patient sees a therapist or other professional to talk about their mental health, they trust their conversations will be private," said Calabrese (D-
"In-depth discussion about a patient's mental health should be kept between a patient and doctor, not a doctor and an insurance company," said Jimenez (D-
Under the bill, information provided to a carrier would be required to be marked "Confidential" and, if directed by the patient or an authorized representative, forwarded to the attention of a specific individual. The bill defines "behavioral health care services" as procedures, services, or assessments rendered by a health care provider for the assessment and treatment of mental illness, emotional disorders, or substance abuse.
The measure also clarifies that a payer would be prohibited from requesting or requiring information to be provided from a mental health care professional concerning a covered person in any contract or policy.
The legislation now heads to the Assembly Speaker for further consideration.