Q:  Liability or Insurance Panel Applications that Ask about any Serious Mental Health Diagnoses

From your experience with patients or peers, how would you say a recently (1 yr) diagnosed BP II in a professional position, could best complete liability or insurance panel applications that ask about any serious mental health diagnoses?  Can I say bipolar spectrum or would that be considered evasive? Would it help to add that there have been no hospitalizations or suicide attempts?  Are monthly appts with a psychiatrist looked at as a safety net, or as ongoing trouble? If meds have to be tweaked up or down (seasonally), can I still say I am stable? Have you heard of people being denied even if there are no other negatives? Any thoughts would be helpful.


Dear Ms. A --

This is a common question but that does not have a very good or clear answer. There are at least three different kinds of disclosures relevant here, probably more. First, let us take applications for medical insurance, although I think you are asking about two others we will examine in a moment.

Some medical insurances, for example when one switches policies, have a "pre-existing conditions" limitation. How one answers questions about this depends on the severity of your condition. In some cases, one might be able to use the fact that subtle versions of bipolar disorder are "undiagnosable" by DSM criteria to avoid having to list that condition, although in many of those cases one would probably have to list "depression" unless one has not been treated for it.

I think, however, that you are asking about professional liability insurance such as for a medical professional. In this case, to make sure there is no way your policy could be called into question, I think you are forced to list Bipolar II if that was a formal diagnosis that has been entered into a medical record for you, somewhere. If that was the diagnosis, you would have to use Bipolar II as such; otherwise I often choose BPNOS as it is even more vague and requires someone to do some homework to understand it which may keep them from doing so unless they are really invested.

As for insurance panel applications, in my view they have no business asking. They don't ask about other conditions that might limit your ability to serve patients, such as diabetes or cardiovascular disease. What gives them the right to ask about mental health conditions? I think this is a continuation of a long-standing stereotype and can be justly refused by simply omitting that information, although this is my opinion and if there were any question about it, you might want to consult an attorney.

Although I'm laughing as I say this, I doubt there are any circumstances in which monthly appointments with a psychiatrist are looked at as a good thing. Indeed, I think they are generally viewed as "ongoing trouble", as you put it.

Adjusting medications up and down is the norm for this condition, even when things are "stable", with the goal of achieving the absolute optimum balance between symptom control and side effects/ongoing risks. Therefore such medication adjustments are definitely within the realm of "stable".

I have not heard of people being denied professional liability insurance nor being prevented from joining an insurance panel because of their diagnosis, but I would only know from my own patients, only a few of whom are medical professionals, so I don't have an adequate database to give you a good answer on this one. I can imagine that it could have been, given the way the world works.

Good luck with all that.

Dr. Phelps