Accuracy of diagnostic information submitted to an insurance company

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Abstract
Findings from two studies of the utilization of the mental health benefit under the Washington, D.C., area Blue Cross and Blue Shield Federal Employees Program suggest that diagnostic information submitted to insurance companies on claims forms is often inaccurate and therefore of little use for claims or peer review. The authors conclude that inaccurate information is submitted primarily because of legitimate concerns about patient confidentially. The urge that special claims and peer review procedures be developed to assure confidentiality of sensitive clinical information. A pilot project developed by the Washington Psychiatric Society and Blue Cross and Blue Shield is offered as an example of the kinds of systems that need to be devised.

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