Protecting Your Privacy in a Changing Healthcare Landscape

For more than a decade, providers at The Thought Loft accepted insurance payments for services because we strongly believe mental health care should be accessible to everyone. Our commitment to equity has guided our practice since the beginning: a person’s financial privilege should not determine whether they can receive psychological support.

Over the past several years, however, the structure of insurance-based mental health care has changed in ways that increasingly affect both privacy and clinical practice.

In order to bill insurance, clinicians are required to assign a mental health diagnosis, often after only one meeting. We are also required to document symptoms in medical necessity language and submit treatment plans and clinical updates for review. In order to submit for payment, we must submit information through billing and claims systems operated by multiple outside organizations.

Mental health diagnoses, once submitted to insurance, become part of a medical record and in certain circumstances may later be reviewed during legal proceedings, disability evaluations, licensing applications, security clearances, or applications for safety-sensitive positions. Prior to the Affordable Healthcare Act, diagnoses could also be used under pre-existing conditions exclusions, sometimes rendering a person unable to secure a health insurance policy. Our responsibility is to make sure clients understand this information so they can make informed consent about who accesses their private healthcare information.

It is our opinion that insurance systems put pressure on clinicians to diagnose quickly, standardize treatment ignoring important contextual factors, and justify care in ways that do not always reflect how psychological treatment ethically unfolds. Individualized, quality assessment and treatment often requires time. Some concerns should not be labeled immediately, and some individuals benefit from careful evaluation before a diagnosis is applied.

In addition to privacy concerns, the financial structure of insurance-based care has also become increasingly unpredictable for providers. In recent years we have experienced:

• delayed or denied payments for services already provided, sometimes more than 6 months delayed
• retroactive claim recoupments months after payment
• shifting reimbursement policies with little notice
• extensive administrative requirements simply to secure payment

In many cases, clinicians provide care in good faith only to later learn the service will not be reimbursed. When insurance declines payment after treatment has occurred, the financial burden frequently falls either on the client or the provider to accept the loss of payment. We do not believe either should be placed in that position. When third-party reimbursement determines whether care is compensated after it has already been provided, clinicians assume a level of financial risk that can ultimately affect the availability and continuity of services.

Because of these realities, we believe the most protective and transparent model is one that minimizes outside access to sensitive mental health information and removes third-party financial decision-making between clients and their clinicians. For these reasons, The Thought Loft is transitioning to a confidential, independent model of psychological care.

In this model:

• your mental health provider, not an insurance reviewer, determines the pace of treatment
• a diagnosis is only recorded when asked for by client or clinically indicated
• your records remain within the practice rather than being routinely transmitted to external claims systems
• care focuses on understanding the whole person rather than meeting billing criteria

Our values have not changed. However, our understanding of how best to protect the people we serve under the fluctuating health care system has.

This transition will occur gradually throughout 2026 as we conclude insurance contracts. We will continue to provide superbills for clients who wish to pursue out-of-network reimbursement and we are happy to help you understand how that process works.

It is our goal to provide a place where you can speak openly and receive care guided by clinical judgment, privacy, and the therapeutic relationship rather than insurance company’s administrative requirements.