The Psychiatrist–Patient Privilege and Third-Party Payers: Commonwealth v. Kobrin

Abstract

Virtually every state gives psychiatrists’ patients a broad statutory privilege to prevent the disclosure in legal proceedings of information about their diagnosis and treatment. Although the precise scope of the privilege varies from state to state, and a variety of exceptions are widely recognized, the contents of therapy sessions—and hence of psychiatrists’ written records of therapy sessions—are ordinarily protected by the privilege. Patients thus are gmerally entitled to prevent the courts and other government authorities from using their coercive evidencr-gathering powers to obtain psychiatric records or testimony about therapy. In conjunction with psychiatrists’ ethical and legal duties of confidentiality toward their patients outside legal proceedings, the privilege renders the privacy of the psychiatric relationship to a large degree sacrosanct.The cloak of secrecy around the psychiatrist-patient relationship, however, must inevitably be lifted to some extent when third parties pay for psychiatric diagnosis and treatment. Any third-party payer, be it a private insurer or a government agency (such as Medicaid or Medicare), must be able to obtain enough information about psychiatric services to determine the propriety of claims for payment for those services.