Protecting Adolescent Confidentiality Under Health Care Reform

Protecting Adolescent Confidentiality Under Health Care Reform:

The Special Case of Explanation of Benefits (EOBs)

Authors: Kathleen P. Tebb, PhD, Erica Sedlander, MPH, Gingi Pica, MPH,
Angela Diaz, MD, MPH, Ken Peake, DSW, Claire D. Brindis, DrPH

Health insurance plans automatically and routinely send communications to health plan policy holders regarding services accessed by any family member covered under their plan in the form of EOBs. The intent of EOBs are to hold insurance companies accountable and to reduce insurance fraud. However, the practice of sending EOBs to the primary insurance policyholder threatens the confidentiality of dependents seeking services (especially sensitive services such as sexual/reproductive health, mental health and substance use) under the primary policyholder’s plan. This issue is exacerbated under the Affordable Care Act (ACA) where more individuals are enrolled into private health plans including young adults who can now remain on their parents’ plans. This lack of confidentiality for dependents is an access to care barrier. Currently, there is no well-defined plan at the national level to address this problem. The purpose of this study was to interview a number of health policy and provider experts to identify strategies that are being implemented around the country to address this problem; to better understand the pros and cons of each strategy; and to inform future directions.

This study was conducted by: The Philip R. Lee Institute for Health Policy Studies and the Division of Adolescent Medicine, Department of Pediatrics, UCSF Benioff Children’s Hospital, at the University of California San Francisco;
ICF International and the Mount Sinai Adolescent Health Center.

The report can be found at: http://bit.ly/EOB-PolicyBrief