Because of stigma and discrimination, treatment of mental illness has frequently been subsequently used—particularly by employers, insurance companies, and law enforcement officials—to harm the life situations of persons with mental illness. Employers who self-insure for health care have frequently used health records to terminate from employment or otherwise put at a disadvantage persons with mental illness merely because they have received mental health treatment. Clearly, a wall must be built to protect patients’ health records from employers and law enforcement.
The issue is more complicated within the boundaries and confines of a health plan itself. Health plans are designed to coordinate and integrate care between treatment providers. Health plans benefit from sharing clinical information to avoid such mishaps as medication contraindications. In an age of managed care, health plans use clinical information to perform utilization review, to make payment decisions, and to promote consistency in best clinical practice. Determining at what point it is appropriate for the consumer/enrollee to say no to this sharing of clinical information within a health plan while continuing to expect the health plan to reimburse all provider claims is the central issue of controversy.