By Denise Chrysler and Robyn Rontal
Under the 2010 health care overhaul, millions of young adults in the United States can access health care on a parent’s health insurance policy. That’s a good thing because it means they are more likely to get preventive care that can keep them from getting sick in the first place.
Yet a glitch in the system means that young adults might forgo treatment for conditions they don’t want their parents to know about — such as sexually transmitted diseases.
These young people are afraid, and rightly so, that an insurance company will send an explanation of benefits home to the parent who holds the health insurance policy. And that means Mom or Dad will know about the services they received at the doctor’s office.
Research suggests that young adults ages 19 to 26 will skip a visit to the doctor if they are worried about privacy. In the worst-case scenario, that translates to no treatment at all or delayed care for sexually transmitted diseases, mental health problems, substance abuse, domestic violence, unplanned pregnancies and many other serious and potentially costly conditions.
EOBs do serve an important function. These letters document receipt of health care services, listing specific information such as the type of care, the patient’s name, the provider, total payment made and the date of service. They’re required by law in most states, because they notify the patient about services received and encourage them to report errors or fraudulent billing to the insurer — and in this way, they save money for our health care system.
At the same time, this glitch in the system can negatively affect an individual’s health. For example, if a young woman doesn’t want her parents to know about an unplanned pregnancy, she might delay getting the prenatal care that helps lead to a healthy pregnancy and a full-term baby. If a young man with serious depression doesn’t get treatment, he might end up losing a job, or worse.
And if we consider the effect that this privacy glitch could have on the spread of STDs, it is easy to see this problem as a public health issue.
Chlamydia is the most common STD in the United States, causing more than a million reported cases of infection every year. Yet health plan data shows that chlamydia screening has remained below the 50 percent mark since 2000. Some experts attribute the low testing levels among privately insured young women to concerns about confidentiality.
The tragedy of the situation is simply this: Left undetected and thus untreated, chlamydia can lead to infertility, pelvic inflammatory disease and potentially deadly ectopic pregnancies. If the EOB loophole were fixed, young adults would be more likely to be screened and treated, and we would prevent many of these costly complications.
Privacy concerns might also drive some minors and young adults to visit publicly funded clinics that provide care for STDs and other conditions — usually at a reduced price that the patient pays up front. In that case, young adults get the treatment they need without a breach in privacy due to a billing disclosure. But that means your tax dollars are paying for care covered by private insurance.
These public safety net providers already are strapped trying to care for uninsured patients who cannot get care any other way. Let’s not add to that burden.
So what’s the solution?
Individual states have eliminated EOB requirements when a dependent requests a sensitive service such as testing for an STD. For example, Washington state allows young adults to maintain privacy for such services as long as a written request goes to the insurance company.
Many insurance companies eliminate the EOB when the holder of the policy, in this case a parent, has no financial obligation. But patchwork solutions will not give young adults all over the country the privacy they deserve.
We believe the time has come for a national solution to this problem, one that might follow the example set by the state of Washington. It is time for a national policy or rule that eliminates the EOB requirement when young adults seek access to or treatment for a limited set of sensitive services and conditions.
Young adults are just that: adults. And it is time we give them the privacy they need to access services they need to stay healthy.
Denise Chrysler is director of the Network for Public Health Law in the Mid-States Region. Robyn Rontal is network collaborator for health information data sharing at the Network for Public Health Law in the Mid-States Region. The views expressed in this article are those of the authors and do not represent the position or policy of the Network for Public Health Law or its funders.
“I live with knowledge of my own death,” she told me. “I found out I have the Alpha mutation, and that it will eventually kill me.”
