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 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.
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Vincent Guilamo-Ramos 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, he said.
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.
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