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Is Your Doctor Lying For You?

© Jennifer Miller

You're in a bind. You need help for a mental illness, such as panic disorder or depression, but your health plan doesn't provide any mental health coverage unless the situation is life threatening. Your plan does however, cover sleep disorders. So your doctor offers to submit an authorization request for psychiatric treatment for insomnia, and does not disclose the fact that you are actually suffering from a mood disorder. And so, you get treatment for your depression, and your psychiatrist joins your primary care physician in lying about your diagnosis when it is time to fill out the insurance forms. Sounds like a good plan, doesn't it? But what if your insurance company catches on, or somehow finds out? Then what?

Apparently, the practice of lying to insurance companies is very common among doctors. A recent study shows that doctors approve of using deception to gain psychiatric referrals at least 32.1% of the time. Doctors also lie to get authorizations for conditions such as coronary bypass surgery (57.6%) and to treat a blood clot in the leg (56.2%). Both conditions are life threatening. Many doctors also approved of deception to obtain intravenous pain medication for a terminally ill patient who became nauseous after swallowing pills. Most doctors will not lie to get authorization for such things as rhinoplasty (nose jobs) or any kind of cosmetic surgery.

Observers are troubled by evidence that managed care is leading doctors to omit certain facts, lie, and otherwise mislead insurance companies to get necessary medical care approved for their patients. "Such deception may reflect a tension between the traditional ethic of patient advocacy and the new ethic of cost control that restricts patient and physician choice," the study's authors wrote.

In the case of mental illness, this issue is even more complex. Not only are doctors lying to get psychiatric referrals, some doctors are disguising their patients' mental illnesses entirely. According to a leading general practitioner, Professor Denis Pereira Gray, doctors should consider refusing to answer questions from insurance companies about a patients' mental illness because the information can be used in a discriminatory way. Doctors claim this stems from the fact that many insurance companies are refusing people coverage on the basis of psychiatric history alone. This kind of situation is similar to the debates caused by HIV testing. To this day, some insurance companies will refuse coverage to a person who has had an HIV antibody test, even if the test came out negative. The insurance companies apparently felt evidence of a test meant there must be some risk, or indication of a risky lifestyle. Patients surveyed have reported having applications for insurance policies, mortgages, or even car loans and credit cards denied due to mental health reasons. Many financial institutions will not give out a loan if there is a known risk of suicide, because it can prove costly to them if someone kills themselves, leaving unpaid bills behind.