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Testimony at State House hearing highlights importance of patient confidentiality

Testimony at State House hearing highlights importance of patient confidentiality

July 22, 2015

Yesterday advocates, consumers, health providers, and legislators convened at the Joint Committee on Financial Services public hearing to provide testimony in support of S. 557 / H. 871, An Act to protect access to confidential health care. The bill would eliminate frighteningly common confidentiality breaches in health insurer communications by allowing patients to choose where and how they receive explanation of benefits (EOB) forms.

Insurers routinely send out EOBs detailing the type and cost of medical services received to the primary subscriber of a health insurance plan, not the individual patient who accessed services. Sensitive health information is frequently disclosed in these forms, violating the basic right to privacy for anyone enrolled as a dependent on another’s policy, such as a young adult, minor, or spouse. As we heard from bill sponsors Representative Hogan and Senator Spilka, Attorney General Maura Healy, Representative Brodeur, and four separate panels of experts, providers and consumers, the effects of this can be devastating.

The first to offer testimony in support of this bill were lead sponsors, Representative Kate Hogan and Senator Karen Spilka. They set the stage by emphasizing the moral impetus to provide confidential health care, also alluding to the negative outcomes of confidentiality breaches via EOBs such as greater likelihood to delay or forgo care, retaliatory abuse from a spouse or family members, and higher costs to publicly-funded community clinics. As Senator Spilka noted, sending member-level EOB forms as this bill proposes is a common sense solution for a shockingly simple problem -- and since some health insurers are already doing this, “clearly it should not be an issue”.

Attorney General Healey testifying at hearing for privacy protection legislation 7-21-15Following Representative Hogan and Senator Spilka was Attorney General Maura Healy (photo at left courtesy of Shira Schoenberg / The Springfield Republican). In addition to reiterating the importance of confidentiality and the negative effects of confidentiality violations, Attorney General Healy also commended the public education aspect of the bill, which would inform patients and consumers of their rights to alternative private EOB communication methods and how to go about requesting those. Her eagerness for the AG’s office to work with the committee on this legislation was palpable and we look forward to having her expertise engaged on this issue!

After hearing from public officials (including Representative Paul Brodeur who voiced his support), four separate panels spanning an array of health issues brought a human face to the bill, offering firsthand testimony about the very real effects of confidentiality breaches through EOB forms. We heard from providers at university health clinics, domestic violence and sexual assault advocacy and service organizations, behavioral and physical health providers, and patients themselves.

Advocates testifying at hearing on privacy protection legislationMany providers described the chilling effect of confidentiality concerns on their patients’ health practices, including forgoing mental health counseling and medication or sexual health services such as STI testing out of fear of reprisal from a parent or spouse. In one personal patient testimony offered on behalf of an anonymous young woman from Andover, the fear of her parents finding out she’d been to the gynecologist to treat an ovarian cyst -- fear influenced by shame, stigma, and poor communication -- was so fierce that she delayed treatment until her ovary ruptured, almost causing her to lose an entire ovary at age eighteen.

Advocates from the domestic violence and sexual assault fields also testified on the negative effects of confidentiality breaches through EOB forms. A number of service providers offered accounts of patients who had been sexually assaulted and were forced to prematurely disclose their assaults to parents or a partner when they received EOBs detailing the services received. In the case of domestic violence survivors, the consequences could be even direr. Annie Lewis-O’Connor from the C.A.R.E. Clinic at Brigham & Women’s Hospital recalled a patient who, while fortunate enough to access confidential care using a workaround, had initially lied about the cause of her injuries fearing reprisal from her husband if he learned she’d sought treatment through an EOB being sent to their home. In the patient’s own words, her husband had threatened to kill her if she went to the hospital.

The last example also illustrates a critical argument brought up on more than one occasion during the expert testimony -- that is, though workarounds to protect patient confidentiality are sometimes possible, they are often costly and time consuming. For many health care providers, time spent creating workarounds is time that could otherwise be spent providing care for patients. At the Boston Area Rape Crisis Center (BARCC), where nearly fifty percent of medical services are requested for people under 26 who are more likely to be insured as dependents on their parents’ plans, confidentiality concerns were especially pertinent. Because of privacy concerns, said Katia Santiago-Taylor, BARCC has to spend more time helping patients figure out how to navigate not having to disclose their assault when they’re not ready than helping them process their trauma. This also creates undue expenses for providers when they have to waste valuable hours training staff on how to manage privacy issues.

The testimony provided at yesterday’s hearing painted a vivid picture of the human impact of confidentiality breaches via EOB forms and presented a strong argument in favor of protecting patient privacy. As one doctor testified, “When I’m able to provide adequate confidential care, I feel like a better doctor and my patients achieve better outcomes as a result.” We urge the Joint Committee on Financial Services to report S. 557 / H. 871 favorably.

We are working to advance this bill through a broad-based coalition called the Preserving Access to Confidential Health Care (PATCH) Alliance. Our supporters include provider, advocacy and community-based organizations in the fields of reproductive health, sexually transmitted infections, adolescent and young adult health, consumer advocacy, gender identity and sexual orientation, HIV/AIDS, mental health and substance use disorders, and interpersonal and domestic violence. To learn more about the alliance and our efforts, visit www.hcfama.org/coalition/confidentiality-protection.

    - Kate Frisher