Patient confidentiality is widely accepted as a fundamental tenet of health care and is particularly important for sensitive health services, such as sexual and reproductive health, mental health, and substance use regardless of the patient’s age. Yet there are additional confidentiality concerns for adolescents and young adults.
When adolescents and young adults are assured of confidentiality, they are more likely to seek health services, disclose health risk behaviors to a clinician, and return for follow-up care. Concerns about potential confidentiality breaches can result in delayed or forgone care, which can lead to serious consequences, including unprotected sex, unintended pregnancy, untreated STIs, and mental health issues. Adolescents most at risk (e.g., those who report engaging in health risk behaviors, experiencing psychological distress and/or having difficulty communicating with parents) are even more likely to forgo care because of confidentiality concerns than their lower-risk peers. As a result, major health organizations recommend that adolescents have access to comprehensive confidential health services. Despite these recommendations, few teens report having time alone with their clinician for confidential health discussions. Other teens and young adults turn to public health safety net funds or free clinics (e.g., Title X clinics, Planned Parenthood and adolescent clinics to receive confidential care.
Explanation of Benefits (EOBs)
The ultimate purpose of Explanation of Benefits (EOBs) is to hold insurance companies accountable and to reduce fraud. EOBs inform policyholders of insurance claims made and actions taken on their account by anyone covered under their policy (including dependents) so policyholders can verify receipt of services for which they were billed; how much the insurance company pays to various providers; and the remaining balance for which the policyholder is responsible. However, the practice of sending EOBs to the primary insurance policyholder is a major barrier to protecting confidentiality of dependents seeking services under the primary policyholder’s plan.
EOBs typically include a significant amount of personal health information. For instance, EOBs identify the individual who received care, the clinician who provided care, and information about the services provided. The ability to keep client information confidential is further complicated by plans with family deductibles, where joint costs among members of the same health plan are tracked and tallied for the primary policyholder to view, with the purpose of calculating the total amount applied to the family deductible amount before insurance coverage begins to take effect. Neither advocates nor insurers seem to have devised a strategy for ensuring that sensitive services are not disclosed in an EOB. This gap jeopardizes minors’ access to confidential services, which they can legally consent to, but may be unable to access due to fear of exposing the reason for their visit through the insurer’s communication to the policyholder.