An Act Relative to Protecting Access to Confidential Health Care

SD 1174, HD 3059

Sponsored by Senator Karen Spilka and Representative Kate Hogan

 

Confidentiality is Essential

Patient confidentiality is key to the patient-provider relationship.  When confidentiality is not assured, patients are reluctant to communicate openly with their health care providers.  Patients insured as dependents under a health plan of a family member or spouse often experience confidentiality concerns because insurance companies routinely divulge information to the plan’s subscriber about the type of services the dependents receive.  As a result, patients insured as dependents may delay or even forgo essential health care, especially if they fear being stigmatized or harmed as a result of the disclosure.  Insurers must help prioritize and protect patient privacy and ensure the confidentiality of medical information conveyed in insurance communications.

 

Confidentiality is Inadvertently Breached Far Too Often

While a health plan’s subscriber cannot learn what type of care his/her dependents received by calling the health care provider, a written communication called an Explanation of Benefits (EOB) that details the type and cost of medical services received is routinely sent to the primary subscriber each time an enrollee on the plan accesses care.  Sensitive health information is frequently disclosed in an EOB, violating the basic right to privacy for anyone enrolled as a dependent on another person’s health insurance policy, such as a minor or spouse.

 

Who is Impacted?

Lack of confidentiality negatively impacts individuals of all genders and life circumstances, but especially affects:

  • Spouses covered as dependents on a partner’s plan, especially when the partner is abusive or coercive.  Disclosure to an abusive partner or family member can worsen the violence or abuse.
  • Young people under age 26 who are too fearful to take advantage of their health insurance benefits, particularly when accessing sexual and reproductive health care, because their parents might find out.  

 

In order to protect confidentiality, this bill will:

  • Allow insurers to send ‘member-level’ EOBs to each insured individual, rather than to the primary subscriber, and allow enrollees to choose their preferred method of receiving EOBs, including at an alternate address or through electronic means.
  • Establish a policy that EOBs not be issued if no balance remains on a claim, ensuring EOBs are not sent for preventive health services with no cost sharing (e.g., a birth control refill, pregnancy or STI test, or domestic violence counseling session).
  • Require EOBs to provide generic information only, such as “office visit” or “medical care” rather than more explicit descriptions.
  • Require insurers to clearly inform enrollees of their options to request confidential means of receiving EOBs.

 

By enhancing patient privacy, this bill will break down a harmful barrier and encourage people not only to seek vital health care, but also to use their health insurance when they do seek care, thereby reducing the use of government subsidized health care programs.