Insurance billing notices threaten young adults’ confidentiality

(This version of the story modifies paragraphs 12 and 13 to include Guilamo-Ramos’ institution and explain that he wasn’t involved in the study.)

(Reuters Health) - Young adults can remain on their parents’ health insurance policies until they turn 26, but when they use it for counseling, pregnancy tests, addiction treatment or anything else, insurers frequently notify their parents.

These routine billing notifications to parents of teens and young adults pose “a pressing threat to confidentiality,” a Harvard Medical School researcher says in a new JAMA Pediatrics commentary.

“Our current system is ill-equipped to protect sensitive information while simultaneously delivering high-quality, affordable care for this population,” writes Lauren E. Wisk, a professor of pediatrics at Harvard and Boston Children’s Hospital.

As a result, young adults might forgo necessary treatment, Wisk said in a phone interview. She worries that teens and young adults might skip screening for sexually transmitted infections (STIs) if they fear it could lead to their parents being notified.

Since 2010, nearly 7 million adolescents and young adults gained access to health insurance, about half as a result of the Affordable Care Act’s expansion of dependent-care coverage to age 26.

“If we really are going to be serious about how do we get young people to be healthy and best utilize preventive care, then we need to include in that discussion issues of confidentiality,” Wisk said.

Many states require insurance companies to send explanation-of-benefits forms to policyholders. The forms can violate the confidentiality of adolescents and young adults when details of their care are sent to their parents, Wisk said.

A 19-year-old woman, for example, saw her primary-care physician for a routine physical, was diagnosed with a sexually transmitted infection and treated with an antibiotic, only to have her parents receive an explanation of benefits for services rendered and then question her about her sexual activity, the editorial says.

“I’m concerned about helping young people to use the insurance they have to get the care they need when they need it and where they need it, and I think the issues of confidentiality play a huge part in determining how young people use their insurance,” she said.

She suggests establishing legislative policies that limit payer notifications when sensitive services are provided to dependents. In the meantime, she urges healthcare providers to discuss with young adults what information will be disclosed to their parents and ways to possibly avoid sensitive disclosures.

“They can at least say to their young adult patients, this is something that might happen,” she said.

Vincent Guilamo-Ramos, a professor at New York University’s Silver School of Social Work and director of the Center for Latino Adolescent and Family Health, agrees that insurer billing explanations can become a barrier for young adults seeking necessary testing and care.

If adolescents and young adults fear a breech in confidentiality regarding sexual and reproductive health, they have a tendency to forgo screening and treatment, said Guilamo-Ramos, who was not involved in the study.

If teens and young adults “stop seeking care because they are afraid of confidentiality breaches, this will most definitely contribute to the spread of STIs,” he said in an email.

He emphasized the need to simultaneously protect confidentiality and to appropriately engage parents in their adolescent and young adults’ health.

“I’d ask providers to rethink how we can constructively involve parents while protecting adolescent and young adult confidentiality,” he said.

“Parental involvement can delay sexual debut, reduce frequency of sex, increase STI testing, support adherence to treatment, provide ongoing support and guidance in regards to effective use of contraception and STI prevention,” he said. “We need to simultaneously protect confidentiality while appropriately embracing parents as key partners in adolescent and young adults’ health.”

Some states have take measures, and others are contemplating measures, to prevent insurers from notifying parents about their young adult children’s medical records, Wisk said.

SOURCE: JAMA Pediatrics, online January 8, 2018.