Seeking treatment for reproductive or mental health can be a very private matter. How that information is shared with others should be, too.
Now that so many more of us have health insurance, isn’t it obvious that we all should feel safe and comfortable using our coverage?
There are times when the need for a health service, such as treatment for substance addiction, for depression, or for a sexually transmitted infection, require confidentiality. Without our privacy assured, many of us might be afraid to seek this care. Because the insurance ‘subscriber’ (often a parent or spouse, covered at work) receives an “explanation of benefits” notice from the insurance carrier when a service is used, we might not want to use our insurance to pay for that care, either.
PoliticaCT supports Connecticut House Bill 6389, An Act Concerning Explanations of Benefits. If passed into law, this bill will make it easier for people with health insurance to preserve the privacy to which they are entitled, as they seek to use their coverage. Individuals will be informed that the explanation of benefits notice (“EOB,” usually mailed to the subscriber) may, upon request, be redirected instead, by mail or email, directly to the individual or family member who received the care.
The Affordable Care Act has enabled young adults to remain covered by their parents’ health plan until age 26, if their parents agree. I hope we can all agree that these young adults should be strongly encouraged to seek the life-saving reproductive health care, family planning, treatment for substance abuse and behavioral health care that they may need, and that is covered by their insurance. Fear that a parent might become aware of these services could very easily deter a young adult consumer from seeking them.
That said, anyone, regardless of age, should be able to access their health care coverage confidentially. There are any number of reasons why an individual might prefer to inform their family members of a medical condition or procedure, only if and when they feel the time is right, not merely because their insurer has mailed an EOB to the subscriber who (as is often the case) has opened and read it.
While the federal HIPAA law allows individuals to request confidentiality arrangements from their insurer, HIPAA only requires plans to honor that request when the consumer asserts that they would be physically endangered by the subscriber’s receipt of the EOB. Physical abuse is, of course a good reason for suppression of an insurance benefits statement, but information about this HIPAA option is not widely known and is rarely used.
EOB statements were created by insurance carriers to deter provider fraud in the claims process. This bill will not prevent the subscriber from knowing when their plan’s cost-sharing obligations or deductibles have been met.
If you’ve ever worried about seeking necessary care because your privacy was a concern…or if you’ve postponed that care or paid out of pocket for those reasons, please do reach out to your state legislators. Tell them your story. Tell them how important it is for those with insurance to feel safe enough to use it! Ask them to vote for House Bill 6389, An Act Concerning Explanations of Benefits.
— Susan Yolen, PoliticaCT Board Member