Keith Cook, Ed.D., Licensed Psychologist -- 2 Elm St., Waterville, ME  04901

207 - 873 - 2567

•Counseling & Psychotherapy      •Coaching       •Consulting & Training

•Parent Coaching     •Headache & Migraine Treatment (New)

"From Daily Problems to Major Trauma...."

Protecting Your Privacy With No Managed Care


Appointments, Insurances, Privacy & Fees


I urge you to take a few minutes to help yourself by reading this information I have researched for you.  It explains how and why I work the way I do so you can get the most from counseling and protect your privacy whether or not you decide to call me.

Strengthen yourself.  Be informed.



APPOINTMENTS -

To schedule an appointment please call my office directly (207-873-2567) - OR - use my online scheduling service.  Click on this Schedule Yourself link.  This is the quickest way to schedule if you have no questions to discuss first.  You won't have to wait for a call back.  

If you choose to call, you will reach either me or my voice mail.  You won't have to talk with anyone else.  My voice mail is used only by me and provides you with complete privacy. You may leave a message fo any length.  If you have questions to discuss, this is the best option.

If you choose to contact me by email regarding any questions, please remember that email is not confidential.  You should, therefore, not send any personal information which you would not want read by another person.  I will respond to your email inquiries.  (Email)  Just be sure to protect your own personal privacy.

If you are nervous or apprehensive about starting counseling, you will find that I am very willing to discuss that with you, as well as any other questions or concerns you may have.  Most people are nervous at the first session and even for some sessions thereafter. I will do my best to put you at ease, but therapy can be hard work and sometimes uncomfortable.  Most people find the gains they make are worth any discomfort.


• ABOUT PAYMENT -   I accept cash, checks, and credit cards.  (Visa, Master Card, Discover)  

I also participate in the Volunteer for Counseling model. -- For those without insurance and who are unable to pay, this is sometimes an option.  To see if you qualify:  (CLICK HERE)  


• PRIVACY & CONFIDENTIALITY, INSURANCES & FEES -

All counseling arrangements are just between you and me because I work privately... no team meetings to discuss your "case", as is often the practice in agencies and some groups... no clerks or secretaries to type notes about our sessions or look at your file or schedule appointments or take messages.  No electronic records which can be hacked.  You don't have to wonder what information will be taken along in a secretary's memory when they leave their current job or if their office is permanently closed.  This affords you with the utmost confidentiality and privacy and is diefferent from the way most doctor's offices, agencies, and hospitals work.


Privacy is one of the main reasons that doctors, teachers, attorneys, engineers, business people, politicians, military and other professionals go to private practitioners.  And it is often no more expensive.  Here is one example of the risks of privacy breaches with electronic records which are rapidly becoming the norm.

http://khn.org/news/electronic-health-records-theft-hacking/  

And another:

http://health.usnews.com/health-news/blogs/heart-to-heart/2009/02/17/electronic-medical-records-will-your-privacy-be-safe  


FEES AND FILING INSURANCE CLAIMS

If you wish to use your insurance, I provide a superbill document which you can submit to be reimbursed by your insurer.  My policy is payment at the time of the session.  This results in a fee reduction for you because it reduces my overhead.  As such, it is also my own small step towards reducing healthcare administrative costs while preserving your privacy.


When you file with your insurance company for reimbursement, it will likely result in a permanent record of a "psychological disorder", rather than simply a life problem, in your personal insurance file.  (Unfortunately, insurances don't deal with life problems, only "disorders" or "illnesses".)  The superbill contains a diagnostic code which I will discuss with you.  It does not contain other personal details about you.  


If I was signed on with your insurance company, I would often be required to file a report of yor personal information with your insurance company for their approval before you could receive benefits.  Since I have no business relationship with any commercial insurances, your privacy is preserved.  Should you be interested, here are sample copies of the kinds of information insurers collect.  (Managed Care Report01.pdf)   (Managed Care Report02.pdf)


Because of this policy, I am pleased to say that my only commitment in therapy is to you, not your insurance company or HMO.


For most people the superbill reimbursement will work.  You may receive a somewhat smaller reimbursement than if I filed the claim for you and sent your psersonal information to the insurer.  This is the insurer's financial leverage to get you to allow them to control your counseling.  You have a choice IF you have what is called an "out of network option".  That is, the freedom to choose your own professional.  


• Here is a simple form you can use when you send one or a batch of superbills to your insurer for reimbursement to you.  I offer this to simplify the process for you.  Superbill Cover Sheet.pdf


How can you find out if you have an "out of network" option?  If you have it for medical treatment, then you have it for counseling.

1. Check your insurance policy or card.  If you have the policy, it should tell you clearly.

2.  If you have insurance through your employer, ask the HR person or personnel director.  Just ask if you have an "out of network option" in your insurance.  You don't have to say what it is for.  ("I just want to know if I have free choice of health care professionals.")

3.  You can call your insurance company with this same question.  You don't have to discuss or explain your reasons.  Be prepared for the clerk on the phone to try to refer yuo to someone on their list.  This is the choice point where your retain control of your counseling or give it to an insurer to be managed by a person you will never see, who may have no professional training, and whose job is to help secure the company's profits by denying services whenever possible.


It is very unfortunate that this lengthy document is even necessary, but the current stte of affairs with insurances in the United States can be quite damaging to effective counseling.  It requires informed consumers.  I will do my best to explain, so please read on....


• No Managed Care --  I have chosen to remain independent and not be on any insurance company panels or lists.  I do not bill them directly because managed care is actually unnecessary for effective counseling.  Therefore, it makes no sense to report your sensitive, personal information.


- As far back as Novermber 1995, Consumer Reports published the largest consumer focused study of counseling and psychotherpay ever done.  They found that people know when they need to start and stop counseling on their own, and they do.  They do not overuse counseling, and it does not need to be "managed".  Actually, you should be managing your own.


- "You Thought It Was Private".  Well written article explaining the risks and pitfalls for you.  

     http://www.spicewoodgroup.com/insurance_article.asp  

- "Making A Killing -- HMO's and the Threat to Your Health."

     http://www.makingakilling.org  

- "Eleven Unethical Managed Care Practices"

     http://www.nomanagedcare.org/eleven.html  


• Preserving Your Privacy --

My not being on your insurance company list preserves your privacy -- somewhat.  They cannot call me and ask what we are talkng about, how we are working and other very personal information about you, such as -- Are you drinking too much or taking drugs? Are you suicidal? Have you ever been sexually assaulted?  What is your family history?  What are the underlying causes of your difficulties?  If I was on their list and billed them directly, any of that information could go into your permanent insurance record. Counseling information is very personal.  It is not medical information like a sprained ankle or having the flu.  I think you should be informed about this so you can make the best choices on your own behalf.


Unfortunately, I cannot guarantee the privacy of a diagnosis on a superbill once you take it from ym office.  It is then up to you to file or not.  Many insurers pool their patient claims data for other insurers to use via the Medical Information Bureau (MIB), a large insurance data bank located outside of Boston.  According to the Annual Medical Report, "In addition to an individual’s credit history, data collected by the Medical Information Bureau (MIB) may include “medical conditions, driving records, criminal activity, drug use, participation in hazardous sports, sexual deviation, and personal or family genetic history, among other facts.” 


• Privacy Rights Clearinghouse, one of the most highly regarded privacy organizations reports this about MIB...

https://www.privacyrights.org/content/introduction-health-and-medical-information-privacy#medical-information-bureau     

And, if you'd like more, they offer an excellent collection of helpful privacy information:

https://www.privacyrights.org/content/introduction-health-and-medical-information-privacy


"The federal Gramm-Leach-Bliley Act (GLB) allows financial companies such as banks, brokerage houses, and insurance companies to operate as a single entity.  GLB give you the right to be notified about the information-sharing practices of financial institutions.  And you must be given the opportunity to opt-out of theird-party information sharing.  But GLB does not keep information from being shared among affiliated companies."  (Privacy Rights Clearing House web site)


In other words, a bank which also sells insurance can have a free flow of information between it's insurance company and the bank without notifying you.  Detailed personal information collected by the insurance company can be shared with the bank for making financial decisions such as action on loan applications.


Insurance records have resulted in adverse events for some clients... denial of life or disability insurance applications, being faced in court by an opposing attorney who has their insurance records about therapy, negative job decisions by some employers, disallowing entrance to military or government service, and adverse action by some financial institutions.


Yes, employers can sometimes get access to counseling, therapy and medical records.  

http://www.chron.com/news/houston-texas/article/Texas-employers-get-access-to-some-workers-1783917.php     

https://www.privacyrights.org/content/employment-and-your-medical-privacy#employer-sponsored-health-plans


Filing a mental health claim in the name of a child or adolescent has been even more sadly harmful.  Following high school or college graduation some young adults have been denied jobs or promotions in government or the military because of a diagnosis in an insurance file years before.  Family therapy can be a protective alternative if handled properly.


So, if you talk with your insurance company, they will likely tell you that I am not on their list and may try to persuade you that you should see someone who is.  That would be to their financial benefit because they would have control of your counseling and your personal information.


Perhaps most importantly, my not being allied with insurers means that you will not have a faceless strangeer on a phone, possibly even in a foreign country, making decisions about how many sessions you should need, when you should be done, and trying to get you to work faster in order to increase profits for the insurance company.  In truth, the decisions about how long to be in counseling and when to stop are part of the therapy process and belong to you.  Effective counseling practices recognize that people become stronger and wiser as they are supported and encouraged to make such choices for themselves, independently.


Recently, some insurance companies have begun the highly intrusive practice of asking people in therapy to complete on-line questionnaires about themselves, often asking very personal questions.  That information may also become part of the patient's permanent record.  It is done in the name of "improved healthcare" and "cost containment".  In actuality, it is often a profit-making scheme to control and limit your counseling, deny needed care, market pharmaceuticals increase insurers profits.  It is highly likely that this practice will increase if they get away with it.  Some have even put financial pressure on therapists to get their clients to cooperate with the insurance company.  Be forewarned, you can protect yourself.  Information is power.  The more you give away, the less you have.


• "But I thought HIPAA protected my privacy... Doesn't it?"  (see link #1 below)

Even some professionals and employees in many medical offices and hospitals still believe that HIPAA protects your privacy.  They simply are not current with the times.  Many professionals never knew it when government bureaucrats silently changed that one line in the regulations allowing your information to be shared for "health care operations", a giant loophole that serves the insurance and pharmaceutical industries first and foremost.

Closer to home -- Maine law now permits the sharing of healthcare records and information between professionals without patient permission.  Fortunately, some professionals still recognize the ethical importance of getting signed permission especially with respect to counseling and therapy information.


For more information see:  

1.

http://www.hhs.gov/ocr/privacy/hipaa/faq/smaller_providers_and_businesses/260.html

2.

http://www.bottomlinepublications.com/content/article/health-a-healing/identity-theft-risks-with-online-medical-records

3.

http://patients.about.com/od/yourmedicalrecords/a/Who-Has-Access-To-Your-Medical-Records.htm


• MY POLICIES ON SECURITY AND CONFIDENTIALITY

I keep no electronic records because I feel they are not secure enough.  Security is compromised far too often these days.  Computer systems are hacked and devices or hard drives stolen with alarming frequency.  All of my therapy records are paper and twice locked (actually three times) for security reasons.

My records will not be merged with the newly growing Electronic Medical Records.


- Confidentiality and releasing information.  I will readily consult with other professionals you see, such as your physician, if you want me to do so and sign a release.  It is an ethical requirement that I do not share with anyone what you and I discuss.  (It used to be a legal requirement too.)

The only exceptions are if you are clearly intending to harm yourself or someone else (not just having such thoughts or feelngs), or if you are abusing a child or elder.  The law does not protect such information, and I must notify authorities.  It has rarely been necessary for me to do this in all my years in practice because good communication and therapeutic options work.

If I learn from you about others who are abusing, or possibly abusing, a child or elder, then I must report that to the appropriate officials.

Also, if you file a personal injury lawsuit against another, and if the court knows of your therapy record, it can be subpoenaed for the legal proceedings, and I must comply.

- Attorneys, legal action, disability and the law.    If you are facing any possible legal action be sure to let me know. This is not only because it can disrupt counseling, but also because I want you to know clearly, at the start, what you can/cannot expect from me.  I don't want you to feel disappointed or let down later on because you assumed I would provide information.

I do not provide court testimony or send records to attorneys. I do not provide psychological assessments for legal purposes, provide expert witness opinions for the court, provide reports or send records to Social Security or disability insurers for disability claims, nor do I provide testimony in divorce settlements or other legal actions.  If you need an assessment for legal or disability purposes, there are psychologists who specialize in that and can provide it for you.  I will offer referrals if you wish.

The reason for this policy and tight boundaries on your personal information is so that we can have the best possible setting to do the work you called me to do -- effective counseling and therapy for your benefit, not to build a case for someone else to do something.  For excellent results in counseling, you must have all the trust and security posssible that what you share with me will stay with me.

Even the Supreme Court has recognized this in the Jaffee case.  If anyone has to wonder if something they bring up in therapy will show up later ina report or in court, or will work against them in a disability claim or other action, then they would have to be very careful about what theyh say because it could work agianst them.  That would be a very bad situation in which to try to do counseling... and it does happen.  The most difficult issues to bring up in therapy are often the most important.  You need to feel free to bring up anything.


• A Word About Diagnosis.  A diagnostic code is necessary if you are filing a superbill for insurance reimbursement.  This can mislead people into believing that we are engaged in some sort of medical procedures rather than counseling or therapy, which of course we are not.

Generally, a DSM or ICD diagnosis adds little to what we do in our collaborative work together to accomplish your goals. The code is but one piece of information that may have some limited use in our therapy.  Far more useful and productive is to understand the underlying causes of your situation so they can be addressed for your relief.

The DSM is a generally unreliable system created by a group of mental health professionals who after deliberation and discussion of available data sit in a conference room and vote on what to call each group of symptoms.

"Twenty years after the reliability problem became the central focus of DSM-III, there is still not a single multi-site study showing that DSM (any version) is routinely used with high reliability by regular mental health clinicians." -- Prof. Stuart Kirk, UCLA.


• My personal satisfaction comes from seeing clients make important gains... feel better, progress to reach their goals and move on with their lives.  We continue counseling only for as long as you wish.  You are the one who knows best, not your insurance company.

Should you have questons about any of this, I would be happy to discuss them with you.  Just call ....


My best wishes to you,  

Keith

Tel. 207-873-2567