Is it right to force a 25-year old man or woman to share intimate health details with his or her parents or spouse, for instance, when he or she is being treated for a sexually transmitted disease, substance use, or depression?

Under current law, when a health insurance company processes claims for anyone in the family, the policy holder receives an Explanation of Benefits statement (EOB) which provides details regarding the claim, including the identity of the provider, and a procedure code or other abbreviated description of the specific service.

When the EOB arrives, the health plan subscriber can see personal health information for all other family members who are covered as dependents under the health plan. And, no, the existing federal and state medical information privacy rules such as HIPAA rules do not already protect this sort of information, even for other adults in the household. In fact it can be included on an EOB.

Under most ordinary circumstances, this is not problematic, as most parents should be permitted to know what care their children are receiving, and most spouses are open with one another regarding their health and treatment needs. But sharing such sensitive medical information should be a matter of personal choice to the adult who is seeking the care, not a requirement.

In addition, it should be kept in mind that when the policy holder happens to be an abusive spouse or parent, the exposure of a family member’s personal health information on the EOB can be far more harmful. In those cases, putting information about sensitive health matters in the wrong hands could even result in violence.

It is possible that spouses or adult children in dangerous family situations would even avoid needed care for the sake of privacy, resulting in harm to their health.

While the proposed bill protects all adults who wish to keep their health information private, it is especially relevant to the extremely vulnerable population of the abused, who should not be required to make the Hobson’s choice of forgoing needed care just to avoid the risk that the insurance company might disclose sensitive treatment information to their abuser.

A bill currently pending before the General Assembly, Senate Bill 977, gives adult dependents the option to control who can or cannot see the sensitive health information reported on an EOB. Specifically, adults who are covered members under another’s healthcare insurance policy would have an opportunity to designate whether or not an EOB should be issued for a particular service, and if an EOB is to be issued, who would receive it, and how it is transmitted.

The good news is that many plans already have processes in place to address this kind of request, and some even
already restrict the health information that the policy holder can see regarding a spouse or adult child, but the bill would formalize this and require plans to provide this type of protection to any covered adult who opts in. (Minor children would not be granted any new privacy rights under the bill – the health information parents will see on the EOB regarding minors will remain unchanged.)

With these additional safeguards in place, all adults will be able to more freely obtain care for both routine and highly sensitive conditions without unnecessary concern that their personal treatment information will be exposed without their knowledge and approval. The General Assembly should pass Senate Bill 977, and Governor Lamont should sign it.

Ted Doolittle is the State Healthcare Advocate.

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