Your Privacy Matters, But Insurance Companies & Tech Platforms For Mental Health May Not Agree.
In a recent Behavioral Health Business article, they reported on Beacon Health Options plan to record therapy sessions as a way of evaluating successful outcomes in therapy. They also shared that the online mental health service, Talkspace, has already been doing this using AI technology to transcribe the sessions and gather data. The Chief Medical Officer of Beacon asserts that this would be done to determine what skills and interventions facilitated by the therapist in order to drive positive patient outcomes and lower costs. He also suggests that the client identity would be blinded. Prior to being the CMO of Beacon, he was employed at Talkspace. Given that this company is being investigated for practices regarding truth in their privacy practices to consumers, I have a difficult time instilling a lot of confidence in what he says the insurance company will do. Some therapists are reporting that they are being told that they must use the insurance company’s video conferencing platform in order to bill for telehealth services. There appears to be a direct relationship there.
As a therapist, and as a consumer, I have major concerns regarding the ethics of this practice and the potential for possible harm to occur. Though they report that patient-specific data would be protected, what checks and balances are being established to ensure that such protection would be upheld? Who will be the oversight body to determine that they are actually doing that? After all, that data could potentially give them detailed information about you that they could use to raise your rates, possibly deny future coverage or even sell your data to social media technology platforms.
In a recent article in Health IT Security, they discussed how companies like Talkspace and Betterhelp are being questioned by Senators regarding the privacy of data of clients receiving therapy through their platforms. Senator Ron Wyden wrote in the letter to the companies, “Unfortunately, it appears possible that the policies used by your company and similar mental health platforms allow third-party Big Tech firms and data brokers, who have shown remarkably little interest in protecting vulnerable consumers and users, to access and use highly confidential personal and medical information.” In addition, he and colleagues stated, “A February 2020 investigation found that BetterHelp was sharing analytics with Facebook about how often users opened the app and metadata from every message shared on the platform – giving the company a sense of when, for how long, and where users were using mental health services.”
This should give us all cause for concern. In the letters, the Senators also stated, “BetterHelp advertises that your services are ‘100% private’ and operate in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), but several facets of your services are not covered by HIPAA, and your company appears to be taking advantage of the ‘regulatory gray area’ in which mental health applications operate to juice your profits.”
Aside from the insurance company potentially learning more about you, there are other ways our health data could be used in ways that we may not want.
Therapists are required to maintain progress notes. These notes are supposed to be a simple narrative that describes observable information on the client’s functioning during that appointment, what goals we worked on, what interventions were used, and the client’s response. Generally speaking, in order for the client confidentiality to really be upheld, specific details are to be used sparingly if at all. These notes could potentially be subpoenaed and end up in court, which is why they are to be written with minimal specificity. If our sessions are recorded, transcribed and maintained by the insurance company, could those transcriptions or recorded videos then become subpoenaed?
Does this open a Pandora’s Box of precedence for any health services covered by insurance to be videoed in order monitor patient outcomes? I don’t know about you, but that raises giant red flags for me! I don’t want the conversations that I have with my medical professionals listened to, let alone taped and monitored. Spend some time thinking about the vulnerable positions you have been in throughout your life when you were receiving medical treatment. Are there any you would not want the insurance company to have a direct observation window in which to evaluate the efficacy of the outcome? As a woman with a history of reproductive health challenges, I can think of numerous procedures I would not want them to witness. You might be thinking, I thought this was about therapy, why are you mentioning that? Because, once something like this becomes commonplace in one form of the industry it can easily become instituted in another.
There are many reasons privacy and confidentiality are important to our health care practices, whether it be mental or physical. First, in order for therapy to be effective, one must be honest with their provider. Without honesty, we can’t work on changing the stuff that is creating the challenges. That level of honesty is HARD for a lot of people. One reason might be because they carry so much shame about things that have happened to them or that they have done and for which they have been chastised and judged in the past. Trust and safety have to be built in order honest disclosure to occur in those cases. Having the knowledge that the insurance company is snooping in might make that difficult, if not impossible for some clients, and unintentionally increase resistance to participation. For many individuals, this could be the cause not to seek support at all.
If you use insurance to cover your services, they have a right to audit your files. As I said earlier, those progress notes typically do not contain the details of what was discussed in the appointments. Having unrestricted access by the insurance company – a company that does not possess objectivity in this case – is not sound clinical research.
The best way to effectively protect your confidentiality is to pay for your services out of pocket instead of using your insurance benefits and avoid using large scale tech firms that are acting as “Brokers” for your treatment.