Report

Confidentiality for Individuals Insured as Dependents: A Review of State Laws and Policies
Jane Levine
,
Rachel Benson Gold
,
Elizabeth Nash
 and
Abigail English

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Key Points

• Privacy concerns about health information can be important for individuals of both genders in diverse life circumstances. Confidentiality can be a factor when individuals are seeking a broad range of health care services, including substance abuse treatment, mental health care or services related to intimate partner violence. Privacy issues may be particularly acute for individuals seeking sexual and reproductive health care, including contraception, pregnancyrelated care, and testing and treatment for STIs, including HIV.

• Despite widespread recognition of the importance of maintaining patient confidentiality, billing and insurance claims-processing procedures widely used in private health insurance today— most notably, the practice of sending explanation of benefits forms (EOBs) to a policyholder whenever care is provided under his or her policy—routinely violate confidentiality for anyone, often a minor or a young adult, insured as a dependent.

• This report reviews state-level legal requirements related to confidentiality in private insurance. It assesses state statutes and regulations that can have the effect of abrogating confidentiality through a number of different avenues and examines steps some states have taken to protect confidential access to care for individuals insured as dependents.

• Laws in almost all states can preclude confidentiality for dependents. About half the states either require or presume the sending of an EOB. Legal requirements often affect broader claims-processing procedures, with virtually all states requiring notices when claims are denied and many addressing issues that arise in the context of divorce and child custody.

• At least eight states have adopted statutes or regulations that could provide a starting point for giving dependents the confidentiality protection they need. However, it is important that the extent to which these existing policies protect confidentiality in actual practice be fully investigated before they are looked to as approaches that might be adopted more broadly.

1. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Summing Up: Final Report on Studies of the Ethical and Legal Problems in Medicine and Biomedical and Behavioral Research, Washington, D.C., Mar. 1983, , accessed Feb. 28, 2012. 2. American Medical Association, Patient physician relationship topics: patient confidentiality, no date, , accessed Feb. 28, 2012. 3. U.S. Department of Health and Human Services, Strategic priorities: put children and youth on the path for successful futures, Jan. 2012, , accessed Apr. 24, 2012. 4. Centers for Disease Control and Prevention (CDC), Winnable battles, Feb. 2012, , accessed Apr. 24, 2012. 5. U.S. Department of Health and Human Services, Leading health indicators: Healthy People 2020, Mar. 2012, , accessed Apr. 25, 2012. 6. Jones RK et al., Adolescents’ reports of parental knowledge of adolescents’ use of sexual health services and their reactions to mandated parental notification for prescription contraception, Journal of the American Medical Association, 2005, 293(3):340–348, , accessed Feb. 28, 2012. 7. Reddy D, Fleming R and Swain C, Effect of mandatory parental notification on adolescent girls’ use of sexual health care services, Journal of the American Medical Association, 2002, 288(6):710–714. 8. Kaiser Family Foundation, SexSmarts: A Series of National Surveys of Teens About Sex. Sexually Transmitted Disease, 2001, , accessed June 11, 2012. 9. Gold RB, Unintended consequences: how insurance processes inadvertently abrogate patient confidentiality, Guttmacher Policy Review, 2009, 12(4):12–16, , accessed Feb. 28, 2012. 10. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Healthy People 2020, Family planning, no date, , accessed Jan. 5, 2011. 11. Commonwealth Fund, Performance snapshots: Prenatal care in the first trimester, 2006, , accessed June 11, 2012. 12. CDC, STDs & Pregnancy - CDC Fact Sheet, Feb. 2012, , accessed Apr. 30, 2012. 13. Public Health Service Task Force, Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission, Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States, Sept. 2011, , accessed May 4, 2012. 14. CDC, Gonorrhea - CDC Fact Sheet, Apr. 2011, , accessed Apr. 24, 2012. 15. CDC, Chlamydia - CDC Fact Sheet, Feb. 2012, , accessed Apr. 24, 2012. 16. CDC, The Role of STD Detection and Treatment in HIV Prevention - CDC Fact Sheet, Sept. 2010, , accessed Apr. 24, 2012. 17. CDC, Revised recommendations for HIV testing of adults, adolescents, and pregnant women in healthcare settings, Morbidity and Mortality Weekly Report, Recommendations and Reports, 2006, 55(RR-14):1–17. 18. Hall HI et al., Determinants of progression to AIDS or death after HIV diagnosis, United States, 1996 to 2001, Annals of Epidemiology, 2006, 16(11):824–833. 19. Cohen MS et al., Prevention of HIV-1 infection with early antiretroviral therapy, New England Journal of Medicine, 2011, 365(6):493–505. 20. CDC, Hepatitis B FAQs for the public, Mar. 2009, , accessed May 4, 2012. 21. CDC, Genital HPV Infection - CDC Fact Sheet, Feb. 2012, , accessed May 4, 2012. 22. American Academy of Pediatrics, Achieving quality Guttmacher Institute 21 34. 45 CFR §§ 164.506. 35. 45 CFR §§ 164.508. 36. HIPAA Consent Form, Item 18239, , accessed June 11, 2012. 37. Bush J, The HIPAA privacy rule: three key forms, Family Practice Management, 2003, 10(2):29–31, , accessed Apr. 25, 2012. 38. Aetna, Explanation of benefits (sample medical), no date, , accessed Apr. 26, 2012. 39. Blue Cross and Blue Shield Association, Explanation of benefits, 2012, , accessed Apr. 26, 2012. 40. Blue Cross and Blue Shield of Minnesota, Our company: Values. Preventing health care fraud, 2012, , accessed Apr. 26, 2012. 41. Humana, Humana’s efforts to prevent and detect fraud, no date, , accessed Feb. 29, 2012. 42. Fox HB and Limb SJ, State Policies Affecting the Assurance of Confidential Care for Adolescents, Fact Sheet No. 5, Washington, DC: National Alliance to Advance Adolescent Health, 2008. 43. Patient Protection and Affordable Care Act of 2010, Pub. L. no. 111–148, Mar. 23, 2010. 44. Sommers BD, Number of young adults gaining insurance due to the Affordable Care Act now tops 3 million, ASPE Issue Brief, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, June 2012, , accessed June 28, 2012. 45. English A and Park MJ, Access to Health Care for Young Adults: The Affordable Care Act Is Making a Difference, Chapel Hill, NC: Center for Adolescent Health & the Law, and San Francisco, CA: National Adolescent and Young Adult Health Information Center, 2012, , accessed May 16, 2012. 46. Brindis CD and English A, Measuring public costs associated with loss of confidentiality for adolescents seeking confidential reproductive health care: How high the costs? How heavy the burden? Archives of Pediatric and Adolescent Medicine, 2004, 158(12):1182–1184. 47. 42 USC § 300 et seq. 48. 42 CFR Part 59. 49. 42 CFR §§ 2.11 et seq. health services for adolescents, Pediatrics, 2008, 121(6):1263–1270. 23. Committee on Pediatric AIDS, American Academy of Pediatrics, Adolescents and HIV infection: the pediatrician’s role in promoting routine testing, Pediatrics, 2011, 128(5):1023–1029. 24. American Academy of Pediatrics, Male adolescent sexual and reproductive health care, Pediatrics, 2011, 128(6):e1658–e1676. 25. Protecting adolescents: Ensuring access to care and reporting sexual activity and abuse. Position paper of the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the Society for Adolescent Medicine, Journal of Adolescent Health, 2004, 35(5):420–423. 26. American Academy of Child & Adolescent Psychiatry, Policy statements: Adolescent pregnancy prevention, Jan. 2009, , accessed Apr. 24, 2012. 27. American Academy of Child & Adolescent Psychiatry, Policy statements: HIV and psychiatric hospitalization of children, Jan. 2009, , accessed Apr. 24, 2012. 28. Ford C, English A and Sigman G, Confidential health care for adolescents: position paper for the Society for Adolescent Medicine, Journal of Adolescent Health, 2004, 35(2):160–167. 29. Committee on Adolescent Health Care, American College of Obstetricians and Gynecologists, Committee opinion no. 460: the initial reproductive health visit, Obstetrics & Gynecology, 2010, 116(1):240–243. 30. American Medical Association, Policy H-60.965: Confidential Health Services for Adolescents, no date, , accessed Apr. 24, 2012, via the AMA PolicyFinder. 31. American Medical Association, Policy H-315.983: Patient Privacy and Confidentiality, no date, , accessed Apr. 24, 2012, via the AMA PolicyFinder. 32. American Medical Association, Policy H-20.915: HIV/ AIDS Reporting, Confidentiality, and Notification, no date, , accessed Apr. 24, 2012, via the AMA PolicyFinder. 33. U.S. Department of Health and Human Services, National Prevention, Health Promotion and Public Health Council, National Prevention Strategy, June 2011, , accessed Apr. 25, 2012. 22 Guttmacher Institute 50. English A and Ford CA, The HIPAA Privacy Rule and adolescents: legal questions and clinical challenges, Perspectives on Sexual and Reproductive Health, 2004, 36(2):80–86. 51. 45 CFR § 160.203. 52. 42 USC § 300gg-13. 53. 45 CFR § 147.130. 54. National Association of Insurance Commissioners, State insurance regulation: history, purpose, and structure, no date, , accessed June 11, 2012. 55. Morreale MC et al., eds., Policy Compendium on Confidential Health Services for Adolescents, second ed., Chapel Hill, NC: Center for Adolescent Health & the Law, 2005, , accessed Mar. 15, 2012. 56. 29 USC § 1002. 57. 29 USC § 1133. 58. U.S. Department of Labor, Employee Benefits Security Administration, Technical Release No. 2010-02, Interim Procedures for Internal Claims and Appeals under the Patient Protection and Affordable Care Act, Sept. 20, 2010, , accessed June 29, 2012. 59. N.Y. Ins. Law § 3234 (Consol. 2011). 60. Conn. Gen. Stat. § 19a-216 9. 61. Wash. Admin. Code § 284-04-510

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confidentiality