Third-party payers and their agents frequently request data
from psychiatric evaluations to make determinations about whether
a hospital admission or a specific treatment modality will be covered
by a particular insurance plan. Despite the blanket consents to
release information to payers that most patients must sign to obtain
insurance benefits, it is useful for the psychiatrist to obtain,
whenever feasible, contemporaneous consent for such communications.
In some instances, it may be necessary to inform the patient what
specific information has been requested and obtain specific consent
for the release of that information. With valid consent, the psychiatrist
may release information to a third-party reviewer, supplying the
third-party reviewer with sufficient information to understand the
rationale for the treatment and why it was selected over potential
alternatives. However, the psychiatrist may also withhold information
about the patient not directly relevant to the utilization review
or preauthorization decision (199, 200).