Peter A Clarke

In Gaining Insurance, Losing Privacy the Atlantic reports on a quirk in the provision of health insurance in the United States which compromises individuals privacy.  Many people have health insurance as part of their parent’s health plan, usually through work.  Accordingly the insurance company sends forms to the insurance policy holder setting out payments under the policy even if those payments relate to treatment of others in the family.  Details of treatment provided is sensitive and intensely private information.  Providing enough details to another member of a family about treatment is privacy intrusive.  This should not be a live issue in Australia given the way in which health insurance operates for adults.  But it does show the need for information to be provided in as secure a way as possible.

The article provides:

When Kristen Church learned she was pregnant last fall, she didn’t want to tell her friends and family right away. So it came as a surprise when her father called her a few days after her visit to the ob-gyn.

“Are you pregnant?” asked Church’s father, who doesn’t live with her.

“He was fine with it, but it’s kind of embarrassing,” said Church, a 24-year-old who lives near Indianapolis. “I don’t want my dad knowing about my ob-gyn visit.”

Church suspects the snitch was her insurance company’s Explanation of Benefits form, also known as an EOB. That’s the statement that the insurance company—Blue Cross Blue Shield, in her case—sends to the insurance policy holder summarizing the doctor’s visit. The form varies between companies, but it usually includes the doctor’s name, the cost of the visit, and the type of service or treatment provided. And because Church is on her parents’ insurance, her father, the policy holder, gets her EOBs sent to his house—standard procedure for most insurers.

Church didn’t think much about the practice until the pregnancy revelation. She makes her own medical decisions, she says, so why should her parents see her insurance documents before she does?

“In my situation, I think I should get everything, not them,” she said. “I’m responsible for the bills, so why don’t I get everything?”

One of the most popular provisions of the Affordable Care Act, or “Obamacare,” is the one allowing adult children to be added or kept on their parents’ health insurance plans until they turn 26. As a result of the change, 7.2 percent more 19- to 25-year-olds are now insured, and 6 percent more report being in excellent physical health.

But the benefit comes with a major downside: Though these individuals are often well into independent, adult life in other ways, it’s often their parents who receive their EOBs by default.

The loophole is especially concerning for women, who might have different reproductive health views than their policyholder parents. In 2013, 45 percent of women aged 18 to 25 were covered on a parent’s plan, according to a survey by the Kaiser Family Foundation

The same survey found that though the vast majority (71 percent) of young women say health privacy is important to them, only 37 percent knew that insurers commonly send EOBs to parents.

The knowledge that parents might see their medical documents can have a kind of chilling effect. Rebecca Steelman, a 21-year-old who lives in Seattle, said she felt compelled to call her parents in California to inform them that an intrauterine device would soon be popping up on an upcoming EOB. They were supportive, but Steelman says some of her friends haven’t been as lucky.

“I have friends who are scared to have that conversation, so they’ll just pay out of pocket or not do the procedure entirely,” she said. “They’re waiting until they’re off their parents’ insurance or they’re not going to do it at all.”

The disclosures to parents can extend beyond EOBs, too, in the form of denied claims, marketing materials, or surveys that innocently ask, “How was your experience at Dr. Psychiatrist’s office?”

Alina Salganicoff, director of women’s health policy at the Kaiser Family Foundation, said that the non-medical details on paperwork are often enough to determine what kind of provider the person visited, which is particularly an issue with “reproductive health services, mental health services, that other services that this group may want to keep private.”

While young adults can ask that their EOBs and other documents be sent to their own addresses, there’s no requirement that health plans accept or honor the request, according to Amy Moy, vice president of public affairs at the California Family Health Council.

Last year, California became the first in the country to mandate that health plans honor such “confidential communication requests” through a state measure that the Health Council co-sponsored. Moy said she hopes that the California law will spur insurers to extend the same privacy protections to young adults in other states.

Another issue, of course, is that many young people don’t know their parents might be receiving their EOBs—because they don’t know what EOBs are. Only about 12 percent of adults have proficient “healthcare literacy,” meaning they understand common insurance terminology.

“A lot of people are not aware that their personal info is being shared if they use their insurance,” Moy said. “For example, I know one college student in Michigan who had a pregnancy scare. Months later, she got a call from her mother like, ‘What is this? I didn’t even know you were doing such and such.’ So one of the things we’re working on is just letting people know about it.”