Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-19T11:24:59.076Z Has data issue: false hasContentIssue false
  • English
  • Français

Health Reform and the Preservation of Confidential Health Care for Young Adults

Published online by Cambridge University Press:  01 January 2021

Lauren Slive  and
Ryan Cramer
Get access Rights & Permissions [Opens in a new window]

Extract

A major issue facing the health of both minors and young adults in the United States is the often unintentional lack of confidentiality maintained in the provision of sensitive health services. Studies have shown that access to confidential care is crucial for minors seeking preventive care and treatment for sensitive services. Evidence demonstrates that many minors will not seek health care if confidentiality cannot be ensured, which can have significant negative health implications; this finding can be extended to young adults covered under their parents health plans. Young adults, not just minors, also often forgo important sensitive services when they face a breach of confidentiality, which most likely occurs when their parents have access to the adult child's health information.

Currently, private insurance companies generally send the policyholder an explanation of benefits (EOB) whenever a service is provided under a plan. EOBs generally include information identifying the patient, provider, type of care received, total charge for services, amount paid by the insurance company, and any financial obligation of the policyholder.

Type
Independent
Information
Journal of Law, Medicine & Ethics , Volume 40 , Issue 2 , Summer 2012 , pp. 383 - 390
Copyright
Copyright © American Society of Law, Medicine and Ethics 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ford, C. English, A., “Limiting Confidentiality of Adoles cent Health Services: What Are the Risks?” JAMA 288, no. 6 (2002): 752–53, at 752. See also American Academy of Pediatrics, Policy Statement, “Achieving Quality Health Services for Adolescents,” Pediatrics 121, no. 8 (2008): 1263–1270, available at <http://aappolicy.aappublications.org/cgi/content/full/pediatrics;121/6/1263> (last visited March 14, 2012). The authors explain, “Confidentiality, both in determining whether youth receive what they need and whether there are opportunities for private one-on-one time during health care visits, is a major factor that affects quality of care for many youth.” Id., at 1263.CrossRefGoogle Scholar
Gold, R. B. Brief, Policy, “Unintended Consequences: How Insurance Processes Inadvertently Abrogate Patient Confidentiality,” Guttmacher Policy Review 12, no. 4 (2009): 12–16, available at <http://www.guttmacher.org/pubs/gpr/12/4/gpr120412.pdf> (last visited March 14, 2012).Google Scholar
Fox, H. B. Limb, S. J. Sheet, Fact, “State Policies Affecting the Assurance of Confidential Care for Adolescents,” National Alliance to Advance Adolescent Health, 2008, available at <http://www.thenationalalliance.org/jan07/factsheet5.pdf> (last visited July 11, 2011).+(last+visited+July+11,+2011).>Google Scholar
42 U.S.C.A. § 300gg-14 (2011). Should the ACA be overturned in its entirety, as of June 2010, 37 states had laws extending dependent coverage to young adult children, although many of those laws vary in substance and age cutoffs. National Conference of State Legislatures, “Covering Young Adults through Their Parents' or Guardians' Health Policy,” available at <http://www.ncsl.org/issues-research/health/dependent-health-coverage-state-implementation.aspx> (last visited March 28, 2012). (last visited March 28, 2012).' href=https://scholar.google.com/scholar?q=4+42+U.S.C.A.+§+300gg-14+(2011).+Should+the+ACA+be+overturned+in+its+entirety,+as+of+June+2010,+37+states+had+laws+extending+dependent+coverage+to+young+adult+children,+although+many+of+those+laws+vary+in+substance+and+age+cutoffs.+National+Conference+of+State+Legislatures,+“Covering+Young+Adults+through+Their+Parents'+or+Guardians'+Health+Policy,”+available+at++(last+visited+March+28,+2012).>Google Scholar
See Gold, , supra note 2.Google Scholar
If, however, the United States Supreme Court holds the ACA to be unconstitutional, then this issue will nonetheless remain as some states still require that dependent coverage be extended to adult children. National Conference of State Legislatures, “Covering Young Adults Through Their Parents' or Guardians' Health Policy,” available at <http://www.ncsl.org/issues-research/health/dependent-health-coverage-state-implementation.aspx> (last visited March 28, 2012). (last visited March 28, 2012).' href=https://scholar.google.com/scholar?q=6+If,+however,+the+United+States+Supreme+Court+holds+the+ACA+to+be+unconstitutional,+then+this+issue+will+nonetheless+remain+as+some+states+still+require+that+dependent+coverage+be+extended+to+adult+children.+National+Conference+of+State+Legislatures,+“Covering+Young+Adults+Through+Their+Parents'+or+Guardians'+Health+Policy,”+available+at++(last+visited+March+28,+2012).>Google Scholar
See Ford, C. Bearman, P. S. Moody, J., “Foregone Health Care Among Adolescents,” JAMA 282, no. 23 (1999): 2227–2234, at 2227. This study found that over 18% of adolescents reported forgone care within the past year. Id.CrossRefGoogle Scholar
Gavin, L. et al. , “Sexual and Reproductive Health of Persons Aged 10–24 Years: United States, 2002–2007,” Morbidity and Mortality Weekly Report 58, no. SS-6 (2009): 1–58.Google Scholar
See Ford, C. English, A., “Limiting Confidentiality of Adolescent Health Services: What Are The Risks?” JAMA 288, no. 6 (2002): 752–753, at 752. The authors explain, “If the majority of adolescents receiving confidential health services in family planning clinics were to modify their use of or stop seeking services, the impact on rates of teen pregnancy and STIs would undoubtedly be substantial.” Id.CrossRefGoogle Scholar
Schwartz, K. Artiga, S. Brief, Policy, “Health Insurance Coverage and Access to Care for Low-Income Non-Citizen Adults,” Kaiser, Henry J. Family Foundation, 2007, available at <http://www.kff.org/uninsured/upload/7651.pdf> (last visited March 15, 2012).Google Scholar
Woolf, S. et al. , Policy Paper, “The Economic Argument for Disease Prevention: Distinguishing between Value and Savings, Partnership for Prevention,” available at <http://www.prevent.org/data/files/initiatives/economicargumentfordiseaseprevention.pdf> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
“When adolescents with privacy concerns do seek health care, many may delay obtaining care, preferentially choose sites that offer confidential care (such as family planning clinics).” See Ford and English, supra note 9, at 752. While it is not known exactly how often young adults with insurance forgo private care for public care because of confidentiality concerns, this is an issue that is anecdotally identified by providers serving such populations, and requires further review.Google Scholar
Health and Human Services, “New Data: Affordable Care Act Helps 2.5 Million Additional Young Adults Get Health Insurance,” available at <http://www.hhs.gov/newspress/2011pres/12/20111214b.html> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
42 U.S.C § 300gg-13 (2011).Google Scholar
U.S. Preventive Services Task Force, “USPSTF A and B Recommendations,” available at <http://www.uspreventiveservices-taskforce.org/uspstf/uspsabrecs.htm> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
HIPAA applies to both minors and adults, but applies differently. States may also have consent or confidentiality laws that apply specifically to minors.Google Scholar
Fox, H. B. Limb, S. J. Sheet, Fact, “State Policies Affecting the Assurance of Confidential Care for Adolescents,” National Alliance to Advance Adolescent Health, 2008, available at <http://www.thenationalalliance.org/jan07/factsheet5.pdf> (last visited July 11, 2011).Google Scholar
See Gold, , supra note 2.Google Scholar
Conn. Gen. Stat. § 19a-216 (2011) (This law also specifies that “A minor shall be personally liable for all costs and expenses for services afforded him at his request under this section”).Google Scholar
Del Code Ann. tit. 16, § 710 (2011). Some exceptions exist. See Del Code Ann. tit. 16, § 710 (1)-(3) (2011).Google Scholar
Fla. Stat. § 384.30 (2011). Some exceptions exist. See Fla. Stat. § 384.30 (2) (2011); Fla. Stat. § 384.29 (2011).Google Scholar
Conn. Gen. Stat. § 19a-592 (2011) (This law also specifies that “[a] minor shall be personally liable for all costs and expenses for services afforded him at his request under this section”).Google Scholar
Wis. Op. Att'y Gen. No. 42 88 (Aug. 26, 1988).Google Scholar
Wash. Admin. Code § 284-04-510(3)(b) (2011) (emphasis added).Google Scholar
Minors face breaches of confidentiality in many states when consent laws exist without parallel confidentiality provisions that address systematic disclosure of health information through payment, billing, and other procedures. Even when confidentially laws are in place, confidentiality may still be violated unintentionally. See Gold, , supra note 2.Google Scholar
See Fox, Limb, , supra note 3.Google Scholar
See Gold, , supra note 3.Google Scholar
Wash. Admin. Code § 284-04-510 (2011).Google Scholar
See 45 C.F.R. § 164.502 (2011).CrossRefGoogle Scholar
45 C.F.R. § 160.103 (2011).Google Scholar
HIPAA permits providers and plans to share PHI with family members in certain circumstances, such as when the family member is involved in the payment for care and the patient agrees or does not object. See 45 C.F.R. § 164.502(g) (2011); 45 C.F.R. § 164.510(b) (2011).Google Scholar
45 C.F.R. § 164.508(a)(1) (2011).Google Scholar
45 C.F.R. § 164.502 (2011).Google Scholar
U.S. Department of Health & Human Services, “HITECH Act Enforcement Interim Final Rule,” available at <http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
42 U.S.C. § 17935(a) (2011). This section specifies that a covered entity must restrict the disclosure of PHI when requested by an individual under 45 CFR §164.522 if: “(1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full.” Id.Google Scholar
Id.Google Scholar
U.S. Department of Health & Human Services, “HITECH Act Enforcement Interim Final Rule,” available at <http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html> (last visited March 15, 2012). 38. 45 C.F.R. § 164.506 (2011).+(last+visited+March+15,+2012).+38.+45+C.F.R.+§+164.506+(2011).>Google Scholar
See Gold, , supra note 2.Google Scholar
Id.Google Scholar
45 C.F.R. § 160.203 (2011).Google Scholar
See 45 C.F.R. § 164.506(c)(1) (2011). A covered entity may use or disclose protected health information for its own treatment, payment, or health care operations. Id.Google Scholar
For example, “publicly supported family planning clinics save taxpayers $3.74 for every $1 that is spent providing contraceptive care.” Frost, J. J. et al. , “Contraceptive Needs and Services: National and State Data, 2008 Update,” available at <http://www.guttmacher.org/pubs/win/contraceptive-needs-2008.pdf> (last visited January 25, 2012). See also Cleland, C. et al. , “Family Planning as a Cost-Saving Preventive Health Service,” New England Journal of Medicine 364, no. 18 (2011): e37(1)–e37(3), available at <http://www.nejm.org/doi/full/10.1056/NEJMp1104373#t=article> (last visited March 15, 2012).Google Scholar
Of course, this approach of ensuring young adult confidentiality could be expanded to encompass additional confidential services in addition to sensitive services advocated for here, but the practicalities of negotiating parental liability for payment for services they may not have knowledge of, as well as its legality, are outside the scope of this paper. Stakeholders should take the confidentiality of services seriously and reflect upon their practices.Google Scholar
42 U.S.C.A. § 17935(a) (2011).Google Scholar
See American Academy of Family Physicians, “Understanding When to Use Modifier-25,” available at <http://www.aafp.org/fpm/2004/1000/p21.html> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
Aetna, , “Clinical Policy Bulletin: Chlamydia Trachomatis - Screening and Diagnosis,” available at <http://www.aetna.com/cpb/medical/data/400_499/0433.html> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
American Academy of Professional Coders, “ICD-10 Implementation,” available at <http://www.aapc.com/icd-10/> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
For a discussion of CPT codes and the process of requesting a new code, please visit the CPT section of the American Medical Association's website. See American Medical Association, “CPT Application Process FAQ,” available at <http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-process-faq/code-becomes-cpt.page> (last visited March 15, 2012). (last visited March 15, 2012).' href=https://scholar.google.com/scholar?q=49+For+a+discussion+of+CPT+codes+and+the+process+of+requesting+a+new+code,+please+visit+the+CPT+section+of+the+American+Medical+Association's+website.+See+American+Medical+Association,+“CPT+Application+Process+FAQ,”+available+at++(last+visited+March+15,+2012).>Google Scholar
Such a solution could also be applied to minors who consent to confidential services, subject to applicable state minor consent and confidentiality laws.Google Scholar
See United Health Group, “Health Care Cost Containment - How Technology Can Cut Red Tape and Simplify Health Care Administration,” available at <http://www.unitedhealthgroup.com/hrm/unh_workingpaper2.pdf> (last visited March 15, 2012).+(last+visited+March+15,+2012).>Google Scholar
See supra note 15.Google Scholar