Is the treatment completely private and confidential?
Will my health insurance company know?
Will my husband/wife know?
Will my employer know?


Your privacy rights are protected by law.

All Medical records are protected by Health Insurance Portability and Accountability Act (“HIPAA 1996”),  and the Privacy Rule (45 CFR parts 160 and 164). 

Medical records pertaining to mental health and treatment of substance use disorders enjoy enhanced privacy. This information is not released without the patient’s consent, except when ordered by a court. 

In the last ten years no court has ordered me to release any medical record pertaining to treatment of addiction. Do not let fear of such an embarrassment prevent you from seeking treatment.

There are regulations that protect the privacy of your treatment, … there are rules for disclosure too.

This information is disclosed to your insurance for payments, pre-authorizations, etc. It includes protected health information including diagnosis, treatment, services provided, along with dates of service.

If you are prescribed controlled substances then this information is disclosed to the State Board of Pharmacy, and your information is accessible to other licensed medical providers and pharmacists, who are required by law to review your prescription history before prescribing or dispensing any controlled substance. And, because of the opioid epidemic this information is now shared between several states.

In the age of internet nothing is private

We all know that Prince died of fentanyl overdose, that Demi Lovato was in hospital after an overdose, and that Ben Affleck has gone to rehab for the third time … so much for privacy. Hopefully you are not that famous … and people would leave you alone.

But why worry about it so much … don’t you think it would be better that they know now … rather than after they find a dead body.

Don’t let this thought, … that others would know, prevent you from getting treated. Getting treated will not destroy you … not getting treated will. If you get treated … others may never know, but if you don’t, and something bad happens, everyone will know.

Did you sign a confidentiality agreement with your drug dealer?

Your drug dealer has your name, phone number, and address. If your drug dealer is arrested then his phone will be searched. Did you sign a confidentiality agreement with your dealer? A non disclosure agreement? Do you know that your dealer does not have to follow any HIPAA rules?

Here is an example to what happened to some people in New York when their dealer was under surveillance and his phone was confiscated.

Daily Mail   NY Post

Doctors and pharmacists are required by law to keep records and that includes records pertaining to substance use disorders.

Your doctor is not going to go about disclosing this information to just about anyone … however there are certain health related transactions that require automatic disclosure of diagnosis.

Your diagnosis of substance use disorder and the corresponding ICD-10 code, for example, F11.20, opioid use disorder, or F10.20, alcohol use disorder, … is required to be disclosed to your health insurance, for the claim to be processed, … and for the doctor to be paid.

Most states now require pharmacists to report all controlled substances dispensed into the state controlled substance database … it has your name, address, medication, quantity, prescriber, dispenser, and payer, … and it must be reviewed before prescribing or dispensing any controlled substance, … that is the law.

This information is also automatically transmitted to the insurance / prescription plan, to see if they cover the medication or will deny it. Most controlled substances require pre-authorizations … that means the medical provider has to fill out an additional form with even more personal information, and fax it to the insurance.

When you use those discount coupons … your personal information automatically goes to those companies that provide you the discount coupon, … and they sell that information.

Your pharmacist is smart enough to know what the medication is for, he does not have to be told, and that means all the sidekicks to the pharmacist that you normally deal with at the pharmacy window may know what you are taking the medication for.

Same applies to the staff in doctor’s offices … they know.

But these are healthcare professionals and they are required to keep the information to themselves. They are required to maintain privacy as outlined in HIPAA regulations. These regulations have been recently relaxed to allow for easy disclosure between emergency res-ponders and providers … family members and next of kin.

Most people who worry about privacy are worried about incidental disclosures … from people who have no imposition by law to keep your information private.

It is difficult to keep it completely private. You go to a doctor’s office for treatment, sit in the lobby and everyone knows what you are there for … because they too are being treated for the same problem

And that latest shiny gadget that every one carries around has a tiny silent camera … and they have not signed any confidentiality agreement with you … your privacy is at their mercy.

You want to sue somebody for violating your privacy … now you have made your information public.

So to get to your questions again …

Do I guarantee that your treatment is absolutely confidential?

No I do not guarantee that. What I guarantee is that I will follow the HIPAA regulations and not disclose your treatment information to anyone who is not authorized to get it.

There are record keeping requirements imposed by law. The records are kept in the office, computer databases, in the cloud. Your mighty government can not keep your data safe and you expect me to keep it safe? … Yahoo and Google and Facebook have been hacked … you think I can’t be hacked?

Stop worrying about it … get treated. 

Will my health insurance company know?

If the doctor accepts your insurance and files a claim … yes your insurance will know.

If your pharmacy checks to see if your insurance will cover your prescription … yes your insurance will know. 

They are the ones paying for it … they will not pay if the claim is not submitted. The claim has to contain all necessary information for them to take a decision, and that includes your personal information, the diagnosis, dates of service, medication prescribed, how much, for how long, why? … and sometimes they want even more information.  

Will my employer know?

I am not disclosing your diagnosis or treatment to your employer. Some people ask for attendance note … even though the note does not disclose your diagnosis or treatment … it has the doctor’s name on it … and if he is that famous doctor who treats addiction … well then they can put it together.

… but I may get fired. 

Yes you may. Why not get treated?

Addiction is considered a disability and there are laws to protect you … but  you will need an expensive lawyer, … believe me treatment is cheaper, might even save your job.

And yes your employer has a legitimate reason to sniff out people who use … for they are a danger to themselves and their co-workers. If your work involves heavy machinery, or you are required to be alert, or are responsible for the safety and welfare of others,  … especially if you work in a medical field, with possible access to controlled substances … your drug use can be a problem.

It becomes really tricky when the employer demands a fitness for duty certificate, or when you disclosed it on the pre-employment application. I have had to fill out forms for some commercial driver license applicants, … one can’t use senatorial language there, the application may get denied … if the answer is not clear and definite.

Don’t let this be a problem … why not get treated, and improve your chances for a better job.

Will my husband or wife know?

You treatment information is not disclosed to anyone without your permission, … but think about it … won’t they know if you overdose, or have a DUI/DWI, or an accident … and have a blood draw, or an urine drug screen, or a saliva swab,  … these drug tests are everywhere. Your car insurance does not want to pay if you were under the influence at the time of accident.

Do you know the average cost of a DUI … $3000 and up, … and that is just the dollar cost, there are other costs too. Why not get treated?

“You can pay now, or you can pay later … it is almost always cheaper to pay now.”

If you are worried about your husband or wife getting to know … then your marriage is already in trouble … treatment might save it. Treatment might even save your life.

An OD is not the way to go … don’t leave a widow or orphans behind, they should not have to deal with your problem.


Additional burden for licensed professionals

This poses a serious problem for licensed professionals and people who have to guard their reputation. If you are rich and can afford it … may be you can go to an expensive rehab away from prying eyes. Unfortunately short term rehab has poor results … and relapse is common, how many times can you afford that kind of rehab. And anyway simply going to rehab … means going away from your business or work, going away from your family and your community, … how do you explain your absence?

It is better to voluntarily and discreetly seek treatment than be forced into treatment by your licensing board. They will impose restrictions on your ability to practice your profession. They have very draconian rules, you have to demonstrate compliance, have your urine drug screens disclosed to them, be monitored by other professionals, … it will be extremely cumbersome, … unpleasant, demeaning, and expensive.

Unpleasant that it might be … getting treated now, will be far less unpleasant.

Many licensed professions have developed assistance programs … which sadly do not provide any assistance other than providing confidential advice … which is … “Get treated”. 

I have the same advice … “Get treated”. Do not wait for someone to accuse you of negligence or worse, … because of your substance use. A blemished reputation is not as bad as a destroyed life … being in recovery is better than being labeled an addict and losing your license. Getting treated takes less effort than … losing your license, getting treated, and then struggling to get your license back.

But if my husband … or wife came to know I will be destroyed. If my employer comes to know about it I will be fired. I will lose my professional license. Yes these are serious concerns … but if you do not get treated, they will anyway know.


You are a commodity … the information about you has value … specially the information about your sickness.

Every prescription that you get at the pharmacy, generates a record about you, … your prescription plan is paying for your medication, so they need to know it, … your pharmacy is required to keep records so they have to have it, and this information can be sold. The US Supreme court has authorized the sale of this information in a case decided in 2011, titled SORRELL v. IMS HEALTH INC. … you can read about it from NPR.

Here is additional information on this subject by Consumer Reports, NY Times, The Guardian, etc.


Minimizing your footprint

If privacy surrounding your addiction treatment is a such a concern, then you can take steps to minimize your foot print.

You can go to a clinic further away … where you are unlikely to bump into someone you know.

Higher end doctors may have arrangements to have you directly seated in a patient room, and leave quietly, without having to hang around in the lobby, checking in at the receptionist, or making a payment at the window.

Look for an addiction practice run by one psychiatrist. They also provide counseling, making it a one stop practice. You get the same medication whether you go to a one man practice or to a famous treatment facility, a small family owned pharmacy or to a national chain.

Talk to your doctor … they may block a longer time for your appointment, they may give appointments in a way that there is no overlap of patients in the lobby. 

Find a location where there are multiple doctors, thus not tying your presence to a doctor treating addiction. Avoid practices which boldly advertise “Addiction Clinic” on their building.

Cash is accepted by most practices, and does not leave a trail involving third parties, and links to doctors or facilities specializing in addiction. You can avoid using insurance for doctor’s visit and medication purchase, that way your personal information and diagnosis need not be transmitted to the insurance. You do have to specifically instruct them not to submit any claims to insurance or to your prescription plan.

Do not ask for time off to see your doctor, arrange it in your off time.

Bottom line is you can not completely avoid a trail, the doctor is required to maintain medical records by law, and the pharmacy has to keep medication records by law.

Do not buy medications from others in an effort to protect your reputation … it may not protect your reputation … and it may end up as a criminal charge.

Do it the right way, get treated … you can make a complete recovery, … and regain the respect of your family and community.

Anyone promising you complete confidentiality is not giving you the complete truth.

Privacy means there is no unauthorized access to your Personal Health Information. That means you have to give permission to the provider to release this information, which is usually done because you need this information to be released for your own benefit.

Examples, when patients have asked me to release their treatment information:

  • a patient needed a letter from me to return to her work … kind of a certificate of fitness for duty. She had taken admission to a hospital for detox, on discharge she joined my outpatient program and her employer demanded a letter from the treating physician that she was fit to work. 
  • a patient needed me to fill out a form required by the medical examiner when he was applying for a commercial driver license, because he had disclosed that he had been treated at my clinic.

Confidentiality relates to information that you share with your medical providers and is an issue of medical ethics. Not all information collected from you is entered in the medical record. I only include the essential information that is required to make a diagnosis of substance use disorder, and that information is what you voluntarily provide.

A good description is provided on this HHS website.

I do not ask any specific information identifying people or places, and probably no medical treatment provider does, … for example where did you get your drugs from? who sold it to you?, etc., is never asked and never entered in the medical record.

Example of what you are asked and is entered in the medical record is your last use, substance used, quantity, etc. You are also asked questions like how long you have used, what all treatment you have received.

You also go through a medical exam and any signs of drug use, intravenous use etc. and the finding is recorded.

When information is released, the law requires that only the minimum information required be released. That means your entire record is not released. I only provide the specific information that is asked for, and sometimes deny the request if the information should not be asked at all. 

The entire medical record can be released at the order of a competent court. I have been asked only once to release a patient’s record … by the disability determination service … a very bright gentleman decided to file for disability on the basis that he is addicted. I don’t think he got it.

There are a few rare exceptions where your information is accessed without your permission. Examples are investigations for Medicare or Medicaid fraud by the patient, … or by the provider. State Medical Boards investigating the doctor., and of course DEA investigations. 


Additional resources:

Recent regulations applicable to confidentiality of substance use disorder patient records, can be found at the following link.

42 CFR Part 2

 


This page was last modified on: October 3, 2018