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In a time of rapidly changing healthcare reform, how can improved legislation enhance patient confidentiality? Can insurers maintain confidentiality for dependents (i.e. adolescents and young adults) remaining under their parent’s plan?

While the law provides protection for individual health privacy through the Health Insurance Portability and Accountability Act (HIPAA), it falls short on privacy concerns by allowing Explanation of Benefits (EOBs) to be sent to the primary account holder (CIGNA, 2009). EOBs are reports of financial responsibility for any health services received. They are important for ensuring the accuracy of bills, “to hold insurance companies accountable and to reduce fraud” (Tebb, 2014).Although limited, some privacy protection under federal privacy regulations require insurers to uphold a patient’s request for confidentiality if releasing the information would put the patient in danger—usually seen in cases of domestic violence.

Such narrow restrictions leave a wide consortium of individuals—such as, dependents receiving “sensitive services” for mental health or reproductive and sexual health services—to face privacy concerns.

Stories of individuals, who have faced issues due to lack of confidentiality reveal the extensive emotional impact these policies can have on both the individual and the family. For instance, Elizabeth Nash was 21 when she had a miscarriage but before she had planned to tell her parents, an EOB of the treatment she had received beat her to it. Nash’s disastrous experience “caused a rift that took a while to repair” (Andrews, 2012).  Experiences like that of Nash’s can potentially lead to detrimental implications on health. Thus—as a matter of providing the highest quality health care—it is imperative to create a balance between “health care transparency and patient confidentiality” (Tebb, 2014). Failure to do so may deter dependents from receiving proper medical care for sensitive issues. This may cause them to hold back on seeking birth control, getting tested for STIs and HIV, and can create avoidable obstacles for patients seeking help for mental illnesses.

The EOB Policy Brief offers an in-depth analysis of possible strategies, and recognizes the limited knowledge on the successes of these “relatively new” approaches. According to the EOB Policy Brief, “the ACA requires no patient/ policyholder cost-sharing for a number of preventive health services” and “the ACA’s inclusion of key preventive health services without cost sharing could potentially reduce the risk of EOBs.” Although, this would only be successful if further restrictions limiting EOBs to services requiring payment were applied (Tebb, 2014).

Confidentiality of health services is a prevalent concern among dependent policyholders and the evolving healthcare field—the expansion of coverage for dependents under the provisions of the ACA—highlight the urgent need for policy reform. Studies have addressed the concerns of patients, policyholders, and insurers through the analysis of possible solution, yet no solution was determined. The need to maximize patient confidentiality protection remains a pressing concern and further research can shed light on the unforeseen consequences and barriers to healthcare these concerns may cause.

Andrews. (2012, October 1). Insurance Dependents Can Face Special Challenges On Privacy. Kaiser Health News.

CIGNA. (2009). Explanation of Health Care Benefits | Cigna EOB. Retrieved from http://www.cigna.com/member-forms/medical-claim-form/explanation-of-benefits

Tebb, K. P., Sedlander, E., Pica, G., Diaz, A.,  Peake, Ken.,  Brindis, C. D. Policy Brief : PROTECTING ADOLESCENT CONFIDENTIALITY UNDER HEALTH CARE REFORM: THE SPECAIL CASE REGARDING EXPLANATION OF BENEFITS (EOBs).  Philip R. Lee Institute for Health Policy Studies and Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco; June 2014.