By letter dated that their representative would review five treatment records, including three open and two closed cases. Then communicated his concerns about patient confidentiality to Magellan. responded with threats of termination from the program. Then terminated and began to inform his Protecting Patient Privacy and Data Security that Highmark would no longer pay for his psychiatric services. Petitioned the court for an emergency preliminary injunction and by Order of dated , it was determined that he was entitled to an administrative review process. After exhaustion of the administrative process, he was advised of his termination by letter. This court then stayed the termination pending this trial.
The court finds that public policy and the standard of care permits third-party payors and those participating in or Utilization Reviews limited access to a review of psychiatric patients’ records. However, the review of five complete patient-review records requested by on was materially in excess of the limited review contemplated by the drafters of the above Code Sections. Refusal to comply with this request was justified, and his termination was not warranted.
The primary issue in this case is whether was properly terminated for refusing to comply with the request to review five treatment records. Contends that this refusal to comply with this request can lead to his termination only if the request was in accordance with all laws, regulations and the standard of care. Testified that he advises patients in the first session that nothing leaves this office and the only exception would be if someone’s life were in danger. Tstifies that the psychiatrist has to be as careful with the records as possible because without confidentiality.
This case presents a significant dilemma to the Court involving countless mental health professionals who find that the administrative demands placed upon them by managed care Patient Data Breach companies conflict with sound patient care. It is the aforesaid administrative demands of insurers, managed care organizations and oversight groups which have been forced upon mental health care professionals in the past few years. These administrative demands have threatened the long standing foundations and tenets of the practice of psychiatry.
A psychiatrist’s non-compliance with the demands of managed care organizations threatens the patient relationship in its entirety since, perversely, the patient’s insurer must approve payment for all treatment and can withhold payment or even remove the psychiatrist from the panel of approved providers. Although stands alone in the caption of this lawsuit, he is, unfortunately, representative of thousands of other psychiatrists who face the same dilemma.