Ensuring privacy in the mailbox

The Boston Globe
January 25, 2015

By Yvonne Abraham

For most of us, it’s junk mail.

After a visit to the doctor, health insurance companies mail out an explanation of benefits, showing the services provided, and how much the insurance covered. Occasionally, the eye-popping cost of a blood test gives us pause, but generally, we bin them without a second thought.

But for some, those simple statements can be a source of embarrassment — or fear.

We take for granted that our visits to the doctor will be kept confidential. But if you get health insurance through your parents or spouse, you can assume no such thing. Because some health plans send those forms describing doctors’ visits not to the patient, but to the person who pays the premiums.

It’s an odd gap in a system obsessed with privacy. And it can cause real problems for some, discouraging them from seeking care, or endangering them when they do.

“There’s a real risk that people are delaying or forgoing treatment because they are afraid of exposing themselves,” said Therese Fitzgerald, director of Women’s Health Policy and Advocacy at Brigham & Women’s Hospital. She and others often hear from women, including victims of sexual assault and domestic violence, who worry statements from health plans will tip off parents or abusers.

Annie Lewis-O’Connor, director of the Brigham’s CARE clinic for victims of sexual assault and domestic abuse, sees at least one of these women a week. She began working to change the rules several years ago, after she heard from a client who was tested for sexually transmitted diseases because she had been raped on a night out with her friends.

“She called me, hysterical,” Lewis-O’Connor said. “The statement came to her home, and if she hadn’t come home early, her husband would have found it.”

She has seen way too many victims of campus sexual assault who were terrified the benefits statement would mean their parents would find out before they were ready to tell them. At the domestic violence program at Boston Medical Center, clients forgo services because the insurance notifications might alert abusers to their whereabouts, or enrage them. At Planned Parenthood, there is a disconnect between the state’s 98 percent insurance rate and the large number of patients paying cash. And it’s not just women: men pay out-of-pocket too, to keep STD screenings or mental health visits private.

“We’re not seeing the full benefits of universal coverage because patients are afraid to use their insurance,” said president Marty Walz. We’re not seeing the full benefits of the Affordable Care Act either, which allows those under 26 to stay on parents’ plans.

Most insurers will send an explanation of benefits elsewhere if asked. But many patients don’t know to ask. A 2013 Kaiser Family Foundation study found that while 71 percent of women aged 18-25 said privacy was important to them, only 37 percent knew statements could go to their parents.

A huge coalition has come together to fix this. Legislation filed by Senator Karen Spilka and Representative Kate Hogan would require insurance companies to automatically send explanations of benefits to the person treated, not the subscriber; and that they send no statement at all for no-copay services.

The legislation would help people in unsafe relationships, but gives more control to all who depend on others for insurance. Similar laws have been passed in California and Maryland, with more states set to follow.

The health insurers see the problem, and want to help, said Eric Linzer, of the Massachusetts Association of Health Plans. But he says employers balk at keeping statements from policyholders, because they want employees to keep an eye on health costs.

Transparency is a great, but it shouldn’t compromise privacy, or safety. For too many people, those slips of paper are much more than ways to keep track of health costs.

They’re toxic.

This column originally appeared here.

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