Time to Protect Patient Privacy in Massachusetts
Learn more about how to utilize these new confidentiality protections:
PATCH Alliance Celebrates Passage of An Act to Protect Access To Confidential Healthcare
Background on the policy:
Your health care should be between you and your doctor. Legislation supported by the Protecting Access to Confidential Health Care (PATCH) Alliance passed the legislatire and was signed into law by Governor Baker on March 30, 2018. The bill, An Act to Protect Access to Confidential Healthcare, sponsored by Senator Karen Spilka and Representative Kate Hogan), was enacted into law (Chapter 63 of the Acts of 2018) and took effect on July 1, 2018.
This law fixes a crucial barrier to accessing health care by ensuring that if you are covered under another person's health plan in Massachusetts—like your parent's or spouse's—your health information will now be kept private. But you have to take action to ensure that your confidentiality is protected.
Patient confidentiality is an essential aspect of the patient and health care provider relationship. Without confidentiality, patients are understandably reluctant to communicate openly with their health care providers and may delay or forgo accessing needed care, especially if they fear being stigmatized or harmed as a result.
Health insurance companies can send a Summary of Payments (SOP) form, also called an Explanation of Benefits (EOB), when a person with health insurance receives medical care. The SOP details the type and cost of medical services that have been provided.
The SOP form may contain information on sensitive health care services, such as care related to sexual and reproductive health, domestic violence, sexual assault, mental health, substance use disorders, HIV testing and treatment, or gender identity related care. When a dependent on the plan, such as a young adult or spouse, is the one who received health care services, sending this form to the policyholder can unintentionally compromise patient confidentiality for the dependent.
Why this matters:
- Young adults and minors are particularly likely to not seek care for sensitive services when worried that their parents will find out.
- Breaching patient confidentiality can worsen violence or abuse, particularly for those patients with an abusive partner or family member.
- Delayed or foregone treatment result in health problems and higher costs down the road.
- Privately insured individuals often utilize publicly-funded community clinics instead of their private insurance because they are afraid that care obtained under their insurance plan will not be confidential. This burdens community clinics that are already facing a shortage of funding and shifts costs to publicly funded programs.
"For the past few years, I have needed mental health and substance abuse services. Some I can get through peer groups, but some I need medically. I am actively avoiding receiving treatment right now because I know that that the Explanation of Benefits will be sent to my father." - Rachel, Boston resident, Age 25
Who is affected?
Disclosing confidential health information negatively affects all people, but especially:
- Adult spouses covered as dependents on a partner's plan, especially when the partner is abusive or coercive.
- Young adults (ages 18-26) insured as dependents on their parents' plan.
- Minors exercising their right to independently access certain protected confidential health care services.
What the PATCH Act does:
The law protects patient privacy in four main ways:
- Health plans must address the SOP form to the patient’s name rather than to the policyholder.
- All patients can choose their preferred method of receiving SOP forms, including at a different mailing address or through an online portal where available.
- SOP forms will contain general information only, such as “office visit” or “medical care,” rather than explicit descriptions of sensitive health care services that could violate confidentiality.
- All patients will have the option to opt-out of receiving an SOP form when there is no cost-sharing (meaning co-pay, deductible or coinsurance) for the health care visit or service.