Is Psychiatric Care Private? Employers, Family and Insurers

What does HIPAA actually protect?

HIPAA is the federal law most people mean when they talk about health privacy. Its Privacy Rule protects your health information in any form, whether electronic, paper or spoken. That includes your name and other identifiers, your physical or mental health condition, the care you receive, and payment for that care.

It does not cover everyone. The rules apply to health plans, health care clearinghouses, health care providers that conduct certain transactions electronically, and the business associates who work for them. Someone outside those groups does not have to follow them. This is general information and not legal advice. If you have a specific legal concern, talk with an attorney.

Will my employer find out?

Employers are not on HIPAA's list of who must follow these rules, but a clinic that does follow them cannot simply pass your information along to your workplace. The more likely routes are ones you take part in: a note you ask for, a form for leave or accommodation, or a conversation you choose to have.

Whether to tell your employer is up to you. Mental Health America explains that employers may ask about mental health only in limited situations, such as when you request an accommodation, and that information shared must be kept confidential, including from coworkers. Rules differ by employer size and situation, so check before relying on them. If you need school or work paperwork, ask us what is possible.

If your insurance comes through your job, ask your plan's privacy office or read its privacy notice to see what the employer's benefits staff can see. Your workplace may also have an Employee Assistance Program, which NIMH describes as a free and confidential service paid for by the company.

What does my insurance company see?

If you use insurance, your plan sees information needed to pay the claim. Information about payment for your care is itself protected, and the plan must follow the same privacy rules. Providers can share information for treatment, payment and health care operations without a signed consent form.

Paying yourself can change this. Under the Privacy Rule, if you pay a provider in full for a service, you can ask them not to share information about it with your health plan for payment or operations, and they must agree unless a law requires the sharing. If this matters to you, raise it before the visit. Our guide on using insurance or paying yourself covers the trade-offs.

If you are on a family plan, ask your insurer where statements and benefit notices go, and whether they can be sent to you directly. Do this before your first claim, because the person who holds the plan may otherwise see them.

Can my family find out about my care?

If you are an adult able to make your own health decisions and you object to sharing, a provider may not share your information with family or friends, according to NAMI's summary of federal guidance. A signed form is not always required, though. Unless you object, a provider may share relevant information with a family member, friend or anyone you identify as involved in your care.

So it helps to be direct: tell your provider who may be told what, and who may not be told anything. If you bring someone to a visit, a provider may reasonably assume you do not object to that person hearing what is discussed. You can also ask to speak alone for part of a visit.

If a person lacks the capacity to make decisions, a provider may use professional judgment to share what is needed in their best interest. Family members may also pass information to a provider at any time, and that does not require the provider to share anything in return.

What about parents and minors?

Generally, a provider may share treatment information with a parent or guardian of a child, and adulthood for these purposes is generally age 18. But state laws vary and some are stricter, so we cannot give one answer that fits every family or every state. Ask us how this works for your family.

Our clinic sees patients ages 5 to 65, and a parent or guardian must be present at appointments for patients under 18. A young person is also given room to speak for themselves. If you are a teen or a parent with a specific worry about what will be shared, it is reasonable to ask about it at the start of the first visit.

When can information be shared without my permission?

Privacy is strong but not absolute. These are some of the general situations to know about, and the list is not complete. It is reasonable to ask any provider what the limits of confidentiality are in their practice, before you share something difficult.

• Coordinating your treatment: providers may share information with other clinicians involved in your care, even without a signed consent form.
• Payment: information may go to your health plan so a claim can be paid.
• Danger to yourself or others: providers may disclose necessary information in certain circumstances, including to law enforcement officials.
• Suspected child abuse or neglect: providers can report this to the authorities.
• Incapacity: if a patient is incapacitated, a provider may share information believed to be in the patient's best interest.
• Legal and government requests: information may be shared in response to a court or administrative order or a subpoena, and for workers' compensation claims and some law enforcement requests.

What rights do I have over my own records?

The Privacy Rule gives you the right to examine and get a copy of your medical records, including an electronic copy, and to request corrections. Providers must also tell you about your privacy rights and how they use your information. Our frequently asked questions page covers common questions about our practice, and you are welcome to ask us anything that is not listed.

You also have your own part in privacy. Join video visits from somewhere you cannot be overheard, and keep your patient portal password to yourself. Our telehealth guide goes through this in more detail.

How does DanShalom Behavioral Clinic handle this?

What you share with us at your visits becomes part of your health record, which privacy law protects. Please keep health details out of the website form and ordinary email. We see patients at our Sugar Land office and by secure video for people physically located in Texas, Idaho, Arizona or Maryland at the time of the visit. With your permission, we can coordinate with your therapist or primary care provider, and you can ask us about any of this before your psychiatric evaluation.

If privacy is what has been holding you back, you can say so when you send a short appointment request. Our insurance page has information about plans and self-pay. DanShalom Behavioral Clinic is not an emergency service. If you are in crisis, call or text 988, or call 911 if there is immediate danger.