Insurer Seeks Return of Fees for Therapy

As reported in the New York Times

For years, health insurers have occasionally demanded a look at psychotherapists' notes of their sessions with patients, to ensure that the care they were paying for was appropriate, or that it actually took place.

But now one insurer, Oxford Health Plans, is saying that in many cases, the notes are not enough evidence that the patients received what Oxford paid for. Oxford has audited hundreds of psychiatrists, psychologists and social workers in the New York metropolitan area, deemed their notes inadequate documentation of the sessions, and demanded repayment of thousands of dollars from each provider — in some cases, more than $100,000. [...]

Oxford audited 300 psychiatrists, psychologists and social workers in the metropolitan region, out of what it says are about 5,000 therapists in its system. The audits, which began last year, reached back to 1997, and the company sent letters seeking repayment this summer.


The crux of the problem, from the therapists' view, is that there are no generally agreed-on rules for session notes. "No one has ever told me what my notes had to contain or how long they had to be," said one audited psychologist, who has been told to return more than $40,000. "On rare occasions, I don't take any notes at all, if the patient says they're uncomfortable with it."

They are getting roasted over a spit slowly because there is no scientific or administrative standard that they adhere to. You can't go back into the notes, apparently, and see what really happened. At least according to Oxford.

Not that I'm going to give them any suggestions. ;-)