I think insurance can mandate certain releases, but you can put limitations on that also. If you choose not to utilize insurance for services, then you can keep your attendence completely confidential and not release info to anyone. I believe that is the same with all medical professionals in the US... Insurance tries to make it more open, but I think HIPPA still trumps insurance companies' insistance to sign releases for anyone and everyone. They may then refuse to pay for services, but that's something to take up with them.

I understand the concept of "continuity of care", but there are times where it's simply not necessary.