February 19, 2016
Society for Adolescent Health and Medicine (SAHM) and American Academy of Pediatrics (AAP) Statement Highlights Confidentiality Risks in Health Care Billing Processes
Oakbrook Terrace, IL – A new statement by the Society for Adolescent Health and Medicine (SAHM) and the American Academy of Pediatrics (AAP) addresses privacy concerns for adolescents and young adults in situations when they might consult a doctor about pregnancies, sexually transmitted infections (STIs), substance abuse, mental health, or any health issue that might require confidentiality protection.
Under the Affordable Care Act (ACA), health insurance coverage was made available to young adults through their parents’ health plans. The SAHM and AAP statement addresses privacy concerns for these young patients attached to medical billing and benefit notices for health services that are sent to their parents. The statement has been endorsed by the American College of Obstetricians and Gynecologists.
“The importance of providing confidentiality protections for adolescents and young adults seeking sensitive services cannot be overstated,” explained lead author Gale R. Burstein, MD, MPH, FAAP, FSAHM. “Efforts to protect confidentiality for these young patients will increase the likelihood that they will seek essential care they may otherwise avoid.”
Explanation of benefits (EOB) and other mechanisms for communicating billing and insurance claims information to policyholders are intended to protect against fraud and ensure transparency for policyholders. However, these EOB statements and other communications may also be associated with unanticipated and unintended negative consequences resulting from breaches in confidentiality.
The SAHM and AAP position paper Confidentiality Protections for Adolescents and Young Adults in the Health Care Billing and Insurance Claims Process makes several recommendations regarding education, billing, health insurance claims and advocacy to improve awareness of the importance of confidentiality for adolescents and young adult dependents in health care billing and insurance communications.
The full position paper is published in the March 2016 issue of the Journal of Adolescent Health; a PDF is available for download at [link]. Key positions included are:
· Health care providers should be able to deliver confidential health services in situations involving STIs, contraception, pregnancy, substance use/abuse, and mental health to consenting adolescents and young adults.
· Policies and procedures should be established to ensure health care billing and insurance claims processes do not impede patient confidentiality for health care services to adolescents and young adults.
· Sending of EOBs or other similar notices should not be required when individuals insured as dependents obtain sensitive services for which they consented.
· Tools should be developed for health care providers to use in discussions with patients about their need for confidential care and explain how billing processes can result in inadvertent disclosure of confidential information and ways to potentially avoid this disclosure.
· Adolescents, young adults, and their health care providers should be informed of ways billing processes can result in inadvertent disclosure of sensitive confidential information.