Better protections of confidential health information of adolescents and young adults in billing and insurance statements are needed, according to a position paper endorsed by the American Academy of Pediatrics, Society for Adolescent Health and Medicine, and the American College of Obstetricians and Gynecologists.
The three societies are calling for policies and procedures to be established “to ensure that health care billing and insurance claims processes such as explanation of benefit (EOB) notifications do not impede the confidential provision of health care services to adolescents” (J Adolesc Health. 2016 Mar. doi: 10.1016/j.jadohealth.2015.12.009).
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To reach that objective, the position paper is calling for the Department of Health & Human Services to issue guidance to clarify “endanger” and “endangerment” in the special confidentiality provisions of HIPAA to make it clear that they include “harms that result when access to important sensitive services, such as contraception and STI services, is impeded by fear of loss of confidentiality.”
AAP, ACOG, and SAHM also endorse the idea that sending EOBs and similar notices “should not be required when individuals insured as dependents obtain sensitive services.”
Dr. Lee Savio Beers, medical director for municipal and regional affairs, Child Health Advocacy Institute at Children’s National Medical Center in Washington, said the policy paper is “a nice summary of what has been best practices for a while and what we really should establish more clearly as best practice.”
She recalled experiences in practice where adolescents told her they did not come for treatment because of concerns that “information would show up on the billing statement to their parents, and they would know that they were seeking care for these issues and then surmise that they were sexually active.”
Dr. Beers added that the position paper could go further in establishing requirements for both parents and caregivers on the importance of confidentiality.
“I think that it is sometimes hard for parents to think about there might be something that my child is going to go to the doctor for that I am not going to know about,” she said in an interview.
“When we see patients for visits, when they get close to their teenage years, we start interviewing them, giving them an opportunity to talk without their parent in the room,” she continued. “Some families are surprised by it. Some are glad that you are asking them to step out. Others want to talk about it for a few minutes, but I think there is an important parent and caregiver education component to this as well, particularly when you start talking about things like insurance benefits, which I think parents typically think of as being really fully within their purview.”