This article is published in partnership with the National Coalition of STD Directors (NCSD) as part of our joint series on STD Awareness.
Nothing is more personal than one’s own body. Patients share private, potentially embarrassing or sensitive health information with their providers. A doctor’s office is seen as a safe space to disclose these personal details, and patients have the right to this privacy. This is true of any age, but is especially a concern for adolescents. Adolescents list confidentiality concerns as the number one reason for delaying or forgoing medical care. Making parental notification mandatory for receiving health care services will completely affect an adolescent’s health choices, so guaranteeing confidential access to health care services is paramount to promoting teen health.
There are a variety of reasons teens may wish to keep their medical care private: perhaps they are embarrassed, afraid of disapproval or violence or maybe the parent is the source of the adolescents’ health concern. Regardless of the reason behind it, ensuring and maintaining adolescent confidentiality should be a priority for the health care community. Most states have adopted various statutory and regulatory mechanisms that allow minors to consent for sensitive services, including the provision of STD treatment and testing, pregnancy testing, contraception, other reproductive health services, mental health services, and substance abuse services.
However, most private health insurance plans send home an explanation of benefits (EOB) to the primary policyholder (i.e. parents and guardians), which can be a major threat to confidentiality for minors and young adults. Medicaid does not specifically require that an EOB be sent, and many states expressly exclude information related to sensitive services received by Medicaid recipients from EOBs, regardless of age. However, that does not make Medicaid immune to breaches in confidentiality. Enrollees must be notified when claims are denied or when payment is due, and these notices may accidentally disclose sensitive information. And health care reform has only intensified confidentiality concerns.
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The Patient Protection and Affordable Care Act of 2010 (ACA), when fully implemented in 2014, will expand health insurance coverage to an estimated 32 million currently uninsured individuals. Medicaid programs will be expanded, and individuals will be able to purchase private insurance coverage through new, state-based exchanges. All of these newly insured individuals will be subject to the same inadvertent breeches of confidentiality that currently occur. Also, as of 2010, group health plans that include dependent coverage have been required to extend coverage to dependents up to 26 years of age. This extension of coverage lengthens the window in which receipt of sensitive services may be disclosed to a parent, if that parent is the primary policy-holder, through an EOB.
As millions more will finally have access to much-needed health care and preventive services, it is more important now than ever that we can guarantee confidentiality. Nineteen million new cases of STDs are reported each year, and young people carry a disproportionate burden of these infections. Fifteen- to twenty-four year-olds account for nearly half of these new cases. Contracting an STD can be a scary and/or embarrassing situation; we need to make sure that our young people aren’t afraid to go see their provider. Ensuring confidentiality is one step towards making sure more adolescents and young adults get screened and receive necessary treatment.