Many minors and young adults have health insurance coverage through their parents’ plans as dependents. The Network was recently contacted by a public health researcher who asked about the tension between health information privacy for dependents and explanations of benefits (EOBs) provided by health insurers.
EOBs are statements provided by insurance companies to covered individuals explaining what medical services were paid for by the company on their behalf, as well as any claims that may have been denied. Most states require that insurance companies provide EOBs. For example, New York’s Insurance Code § 3234 states: “Every insurer . . . is required to provide the insured or subscriber with an explanation of benefits form in response to the filing of any claim. . . .” Among other benefits, EOBs allow insurance subscribers to protect themselves from provider or insurer’s errors and avoid overpaying or paying for services that were not provided.
When the service recipient is a dependent, the parent or guardian as the insurance plan subscriber, may receive EOBs containing details about sensitive services, such as those related to mental health, substance abuse, reproductive health, and sexually transmitted diseases. Some advocates and providers argue that this privacy gap negatively affects the health of minor and young adult populations, and there is data to support this claim. For example, low screening rates for chlamydia among sexually active females aged 16 to 26 have been attributed to patient privacy concerns.
The issues arising from the tension between providing sufficient transparency to subscribers and providing adequate care to minors are complex. There is not yet any well-defined plan at the national level to address this tension. The Network provided the requestor with a variety of resources to address the multiple perspectives and interests at play, including:
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