Confidentiality Protection

Confidentiality Protection

Protecting Access to Confidential Health Care

It's Time To Fix Patient Privacy In Massachusetts

PATCH Alliance Supports An Act to Protect Access To Confidential Healthcare (S. 2138)

Background on the policy

Your health care should be between you and your doctor. Legislation is pending that is supported by the Protecting Access to Confidential Health Care (PATCH) Alliance. The bill, An Act to protect access to confidential healthcare (S. 2138, sponsored by Senator Karen Spilka and Representative Kate Hogan), passed the Massachusetts Senate in March, 2016.

This bill fixes a crucial barrier to accessing health care by ensuring that when multiple people are on the same insurance plan, confidential health care information is not shared with anyone other than the patient.

Patient confidentiality is an essential aspect of the patient-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 insurers routinely send out an Explanation of Benefits (EOB), detailing the type and cost of medical services received, 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's health plan, such as a young adult, minor, or spouse. Therefore, health insurers must help prioritize and protect patient privacy in all communications.

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.

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 Alliance believes:  

  • Insurers are violating patient confidentiality when an EOB is sent to anyone other than the patient. Patient confidentiality is an essential aspect of the patient-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.
  • Breaches in patient confidentiality are a public health problem. If providers can't ensure that care can be provided confidentially, many people will choose not to receive care for sensitive services like STI testing, treatment for HIV, domestic violence counseling, mental health support, or substance abuse support. Leaving these medical needs untreated has the potential for a greater impact that can go beyond the patient.
  • One system for all insurers must be in place to protect consumers' rights. A consistent mechanism for ensuring confidentiality for EOBs is needed, because current practice varies across plans and is confusing for both consumers and health care providers. Without consistent mechanisms across all insurance providers, health care providers are not able to advise their patients about how to confidentially access health care. And if health providers cannot help their patients get health care confidentially, many patients will choose not to access health care they do not want shared with the subscriber.

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About the PATCH Alliance