Standing Up to Insurers Wins Psychiatrists APA Award

What if a psychiatrist had to make a choice between turning patients’ psychotherapy records over to a health insurance company to facilitate reimbursement or violating the confidentiality rights to which he or she thinks the patient is entitled? Two Charlotte, N.C., psychiatrists faced that decision back in 1999. They were Pamela Wright-Etter, M.D., and Kevin Etter, M.D., and they opted for safeguarding their patients’ privacy.

Their decision cost them tens of thousands of dollars in reimbursements from the health insurance company in question and led to extensive psychological anguish, a decision not to participate in other health insurance companies’ provider panels, and their ultimate decision to close their medical practice. As Wright-Etter told Psychiatric News in an interview a few months ago: “This whole thing has cost us dearly. . . . We’ve sacrificed everything for the sake of [patient] privacy and confidentiality and taking an ethical stand” (Psychiatric News, April 20).

In recognition of the stance they took, the Etters received the Assembly’s Profile of Courage Award at last month’s Assembly meeting in Washington, D.C. The award was bestowed on them by Al Herzog, M.D., a past Assembly speaker. They were nominated by Assembly representative Deborah Peel, M.D.

The health insurance company that the Etters battled was Blue Cross and Blue Shield of North Carolina, one of the largest health insurance companies in that state. The Blues claimed that the generic consent-release form signed by the Etters’ patients sufficed for the Etters to turn over the patients’ records, which the insurance company wanted to examine after a patient filed a complaint with the company about fees the Etters charged for a particular service. The Etters disagreed about the consent-form requirement, insisting on relinquishing records only where patients gave their explicit, contemporaneous consent following a specific request. And since not all patients gave their explicit consent—in fact, most refused to do so—the Blues would not reimburse the Etters for some of the psychotherapy sessions, with several of the reimbursement denials made retroactively (Psychiatric News, April 20).

“This was an issue of conscience for the Etters, and they really put their lives on the line for their patients,” Herzog told Assembly members. “Their action serves as an example for all of us.” In a sense, Herzog said, the Etters defined the principle of privacy for psychotherapy. “I would commend to you their courage,” he declared.

After receiving the award, Kevin Etter, M.D., expressed his “heartfelt thanks to the APA leadership. . . for supporting the ethics which this organization puts forth.” APA, along with the North Carolina Psychiatric Association, helped the Etters fight the Blues over the issue and also helped get the Blues to agree to put into practice revised claims-review standards that maintain the privacy of medical records to a much greater extent than was previously the case while still allowing it to review medical care of its beneficiaries.

Pamela Wright-Etter, M.D., also thanked APA for its help. “After about nine months it became clear that we would either have to give in or stand up for what we were trained,” she said. “I know that parity is an issue for us all now, but parity without privacy is really meaningless.” ▪