Some mental health professionals say they are being pressured by Blue Cross Blue Shield of Kansas to release highly personal and confidential notes on their work with some patients.

The therapists said the insurance company and its subcontractor, New Directional Behavioral Health, are demanding the notes to try and limits their costs for patients who need long-term intensive counseling.

Susan Eyman, a psychologist in Lawrence, said when she refused to turn over notes for a patient last year she had to pay back thousands of dollars in reimbursements from the insurance company.

“Of course I can’t,” Eyman said. “If you send this information out there, it’s out there.”

Mental health therapists say the insurance audits and payment reimbursements hurt their ability to treat people who need counseling either several times a week or for a long period of time. They also question whether the tactic violates parity laws that require insurers to cover mental and behavioral health care the same as they cover medical care, The Kansas City Star reported .

The audits are done on only a small number of high-cost providers to determine if the services fit what was billed, said Mary Beth Chambers, a spokeswoman for Blue Cross Blue Shield Kansas said. The company shields all therapy notes and other documents as required by medical privacy laws, she said.

“We realize that claims analysis does not paint a complete picture, which is why we seek documentation to better understand the diagnostic complexity and why the provider believes a specific patient requires a significantly higher number of visits than the norm,” Chambers said in an email.

The audits began after the insurance company made changes two years ago to comply with parity laws, Chambers said.

But the therapists said the audits don’t account for patients who need more counseling than others.

“They don’t care how disturbed people are,” Eyman said. “They don’t care what the level of distress. They don’t figure that in.”

Julie Holmes, the director of health and life insurance for the Kansas Insurance Department, said the agency reviewed therapists’ complaints and found the audits followed parity laws because BCBS Kansas has similar measures for medical and surgical providers.

The therapists contend the audits violate the spirit of the law and the practical effect will be the same as setting the hard limits on the number of visits that the parity law prohibits.

Tom Bartlett, a clinical psychologist in Topeka, said it seems like unless his patients are suicidal, BCBS Kansas doesn’t want him to see them more than once a week. He said that’s enough to help them survive, but not enough to help them thrive.

“You’re probably going to find a lot more adult children with mental illness living in their parents’ house,” Bartlett said. “But if you’re the insurance company, that’s not your worry.”