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Teen confidentiality should not be breached in billing, claims processes: policy :

February 19, 2016
Dr. BlytheDr. BlytheBilling and insurance claims processes need to ensure the confidentiality of adolescents and young adults covered on their family’s health insurance plan. That is the emphasis of a new policy statement, available at, from the Academy and the Society for Adolescent Health and Medicine.

When adolescents seek care for a sensitive issue such as sexually transmitted infection (STI), mental health issue, contraception, pregnancy or substance abuse, they should not have to worry about a breach of confidentiality, according to the statement.

That does not obviate the need for parents to be engaged in the care of their teen. Nor does it take away the need for physicians to assist teens in engaging their parents for support, according to the statement, which is endorsed by the American College of Obstetricians and Gynecologists.

The statement points out that numerous health care professional organizations have formal policies supporting the importance of confidentiality. (See the AAP policy statement Standards for Health Information Technology to Ensure Adolescent Privacy at

Does an EOB risk future care?

One way confidentiality can be breached is when an insurer sends an explanation of benefits (EOB) form to the policyholder. More EOBs are going home now, with expanded Affordable Care Act provisions allowing young people to remain on their parents’ insurance plans until age 26. The law allows coverage of more preventive care, including sensitive services such as STI screening.

If confidentiality is violated, teens may stop seeking essential care. This is especially concerning given the serious consequences of unintended pregnancy and untreated STIs, according to the statement.

The breach also can lead to deeper, long-lasting and even harmful problems with parents or caregivers.

“Although there are positive benefits of parental involvement in an adolescent’s health care, situations exist in which parental notification could place an adolescent at risk of verbal and/or physical abuse or conflict,” the statement reads.

Billing and insurance claims processes need to ensure the confidentiality of adolescents and young adults covered on their family’s health insurance plan. AAP News photo by Jeff KnoxBilling and insurance claims processes need to ensure the confidentiality of adolescents and young adults covered on their family’s health insurance plan. AAP News photo by Jeff KnoxOngoing struggle

Maintaining confidentiality for adolescents and young adults often is a daily struggle for some offices, but good rapport with both patients and parents can be helpful for the teen.

Adolescent medicine specialist Margaret J. Blythe, M.D., FAAP, past chair of the AAP Committee on Adolescence and one of the statement’s authors, is all too familiar with these concerns.

For parents who might not understand the need for a particular service, Dr. Blythe has found herself emphasizing the importance of the ultimate need to protect an adolescent’s health, such as when a younger patient needs ongoing birth control.

Sometimes, “it’s a dance,” she said.

Knowing what resources are available in the community and collaborating with them also is reasonable for pediatricians, she said.

Laws, policies vary

While there are state and federal confidentiality protections for minors and young adults, there is wide variation in state laws that allow minors to consent for various sensitive services. The statement addresses the nuances and discusses special confidentiality provisions of the Health Insurance Portability and Accountability Act (HIPAA) privacy rule.

Other recommendations

The statement calls for the following to help improve confidentiality protections for adolescents and young adults:

  • EOBs and similar notices should not be required when individuals insured as dependents obtain sensitive services.
  • Health care organizations, clinicians and policymakers should explore all legal options for enabling providers to deliver confidential services in the context of health care billing and insurance claims.
  • Insurance plans and health care providers should collaborate to develop simplified ways of allowing dependents to receive confidential care, such as tools to use in discussion with patients about their need for confidential care. A simple procedure should be set up to facilitate a health care provider’s use of the special confidentiality protections included in HIPAA.
  • Health insurers and government agencies should provide information to adolescents and young adults and their health care providers about ways billing processes can result in inadvertent disclosure of confidential information.
  • Research is needed to see if existing or new policies are effective.
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