The answer is Yes and No….
Your insurance will most likely never see your therapy progress notes, but they could ask for them. They will most likely never ask to see your diagnostic assessment (The more extensive notes from your intake session), but they might ask for them. Your insurance WILL see your diagnosis whether or not they make a special request—it appears on the general billing forms.
How are my progress Notes Written?
Many therapists are mindful of this limit to your privacy and they will try to write their progress notes carefully to protect your private details. I personally lean heavily this way in defense of my clients. If you told a therapist like me in session that your boyfriend called you “X” which caused you to move out and post a nastygram about him online…..your progress note might say, “Client appeared triggered due to recent conflict with her significant other.” My writing would be intentionally vague, this way I can remember what we worked on, but your insurance (or anyone else who could at some time request your records) stays mostly out of your business. If you have concerns regarding the clinical writing style of your therapist, just ask them. If you have certain subjects you’d prefer they not write about in your note, they may be able to accommodate some requests.
What else could be released?
Additionally, therapist who comply with HIPAA privacy standards (which all SHOULD) are mandated to only release the minimum necessary information. This means if your insurance requests a copy of your diagnostic assessment, we will NOT send them any additional paperwork or notes. If they ask for notes for a date range between January 1st and 15th and I saw you on January 16th, that note will not be released.
If you release other paperwork to your therapist (such as court orders, letters, information from another provider or clinic, etc—this IS covered by HIPAA and your therapist cannot release it to your insurance. Third party documents are fully private and protected.
I didn’t give my insurance permission!
If you choose to use your insurance to pay for your counseling services, you do sign away certain rights to privacy. Your insurance has the right to know your diagnosis, know the dates and types of services you receive, and even request your clinical notes from your therapist. When you sign intake paperwork with a therapist using your insurance you are specifically consenting for them to have access to this information.
Sometimes clients are concerned about diagnosis, if you are using insurance—you have been given one. Some therapists discuss diagnosis with their clients more than others and some therapists discuss more significant diagnoses, but not the more everyday ones. Some diagnoses are generally considered temporary or not as impairing such as adjustment disorders or anxiety; whereas, others such as schizophrenia, personality disorders, or bipolar depression may be considered more pervasive and can carry more stigma. There are different schools of thought regarding the conversations we have with clients about diagnosis. If you have concerns or questions in this regard, you should ask your therapist. The takeaway for this article- is that whatever your diagnosis, your insurance will know.
Even though insurance is something you pay for to work for you, many people end up feeling like they must comply and follow the rules insurance sets forth without question. You may have to follow certain rules if you choose to bill your insurance for services. If your insurance attempts to limit the number of services you can receive, there still may be ways to appeal this and a good therapist can help you to get the amount and type of therapy services you need. You can choose who you want to provide your mental health care (Unfortunately, insurance sometimes tries to control this one by offering In network benefits far superior to out of network, but the choice is still yours.) Please don’t get your therapy from someone you don’t feel comfortable with—you will get less out of the experience. Ultimately, if you don’t feel comfortable signing away your privacy or trying to follow insurance rules, you can always choose NOT to use your insurance and instead pay out of pocket.
Your mental health is not something to play around with, take your care seriously and advocate for yourself. Don’t avoid getting therapy because of the constraints put upon you, instead ask the questions that matter to you and make choices that work for you.
January 2019, Jennifer Beall, MA, LPCC