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.Abstract Teaser