Concern over health care privacy can have adverse effects on the treatment process. It can create conflict-of-interest concerns for providers, who want to advocate for their patients, but know that if the patient does not authorize disclosure, the treatment may not be approved by the MCO, and the provider may not be paid. In one example, two psychiatrists in North Carolina refused to disclose medical records to Blue Cross Blue Shield when the patients had requested confidentiality. BCBSNC refused to compensate the providers for the care of these patients (Grinfeld, 2001). The conflict between provider and patient interests, and can harm the therapeutic relationship.
Knowing that confidentiality is not guaranteed can make individuals less likely to seek mental health treatment. In a 1998 study, participants who were informed that treatment information might have to be provided to an insurer in order to receive reimbursement reported less willingness to seek psychotherapy (Kremer and Gesten, 1998). Once in treatment, patients may undertake a variety of activities to protect their privacy which can sabotage their treatment, including regularly changing doctors to avoid having a record of all of their care with one provider, withholding information from their provider, or lying about their circumstances or symptoms (Goldman, 1998). The Louis Harris and Associates study found that seven percent of respondents had chosen not to seek care for fear of jeopardizing their career or other life opportunities (Louis Harris and Associates, 1993). These activities can result in patients receiving poor quality care, with potentially serious medical conditions going undiagnosed or untreated (Goldman, 1998).
Individuals who are especially concerned with the stigma of mental health treatment and the risks of disclosure may turn to other treatment methods that may have a different set of risks. Web sites offering counseling services online, in real time, are growing in popularity. The number of providers offering counseling through these sites is expected to grow from approximately 300 today to more than 5,000 by 2005 (Amig, 2001). Patients are attracted to receiving therapy in their own surroundings, with the anonymity that the Internet offers. However, the web sites can have their own security concerns. If a website does not accept health insurance, they may not be governed by the HHS privacy regulations, yet participants must provide their name, address and credit card number for billing purposes. Thus, the individuals, in an attempt to gain greater privacy, may be providing private companies with a great deal of personal information about themselves without considering that these firms may be more vulnerable to hackers or inappropriate disclosures than insurance companies governed by federal privacy regulations.