Protecting Access to Confidential Care
Confidentiality allows patients to make personal decisions about their health care without fear of outside pressure, harassment, or shame. Everyone has a right to high-quality, confidential health care. But before the PATCH Act, many young adults and spouses routinely have their privacy inadvertently compromised.
We changed that. An Act to Protect Access to Confidential Health Care, or the PATCH Act, protects patient privacy and closes this loophole in patient confidentiality.
The Problem: Many Massachusetts residents did not have access to confidential care
Insurance companies routinely mail a document called an “Explanation of Benefits” (EOB) to the primary subscriber of the insurance plan, informing them of the medical services received by dependents, even when there’s no payment due. Often insured on a family member’s insurance plan, dependent subscribers like young adults and spouses are frequent victims of this breach in confidentiality. Many fear their parents, spouses, or others will learn about the doctors they saw, the services they received, or the medicines they were prescribed.
Because of these concerns, many people pay out-of-pocket or forgo the care they need altogether. In fact, 9 percent of young adults and nearly 20 percent of teens do not seek sexual and reproductive health care services because of concerns that their parents might find out. For those with abusive relationships, disclosing sensitive information to a spouse or family member could worsen the abuse.
Our Solution: PATCH protects patient privacy
To better protect patient confidentiality, the PATCH Act:
- Gives dependent subscribers the opportunity to request ‘member-level’ EOBs, sent directly to the dependent subscriber who received the care, rather than to the primary subscriber on the insurance plan.
- Allows dependent subscribers to receive EOBs at an alternate address or over email.
- Prevents EOBs from being issued if no payment is due, ensuring EOBs are not sent for preventive health services (e.g., a birth control refill, pregnancy or STI test, or domestic violence counseling session).
- Requires insurers to use generic information about sensitive health care services on EOBs, such as “office visit” or “medical care” rather than more explicit descriptions of services.
- Requires insurers to clearly inform all subscribers of their options to request confidential EOBs.
After four years of advocacy, the PATCH Act is now law!
In April 2018, Massachusetts patients scored a victory when the PATCH Act was signed into law. Massachusetts closed a loophole in patient privacy and increased confidential health care access for young people, survivors of domestic violence, and anyone else covered on a family member’s health insurance plan.
An Act Relative to Protecting Access to Confidential Health Care
SD 1174, HD 3059
Sponsored by Senator Karen Spilka and Representative Kate Hogan