Assembly passes bill to protect health care privacy
STATE HOUSE – The General Assembly has approved legislation sponsored by Sen. Gayle Goldin and Rep. Susan R. Donovan to protect Rhode Islanders’ health care privacy by allowing people to request that their insurers send health communications directly to them instead of a parent or spouse.
The bill (2021-S 0062Aaa, 2021-H 5370Aaa), which has been transmitted to the governor, would protect survivors of domestic and sexual violence, young adults and others who may have their privacy violated by insurance communications.
“While federal laws have long guaranteed health care privacy rights between a patient and clinician, those protections fall apart when the health insurance industry sends information about the visit to the patient’s home. The details included in the statements that are mailed to insurance policyholders can discourage patients from seeking a medical intervention that they need. We want to make sure everyone feels safe to seek the full range of care: from mental health, to reproductive care, to getting a broken bone set. Our bill will provide an option to protect patients who need health care without their family knowing all of the details,” said Senator Goldin (D-Dist. 3, Providence).
Many insurance companies routinely send disclosure statements – known as Explanations of Benefits (EOBs) — to the policyholder’s home address whenever anyone on the plan receives a health care service. The EOB describes the service, such as “psychotherapy,” and lists the service provider. Some EOBs are addressed to the patient receiving the service if the patient is a teen or adult, but by default the EOB is sent to the policyholder’s mailing address. For instance, a spouse living in a domestic violence shelter might access mental health counseling, and their abusive partner who is the insurance policyholder could then receive an EOB in the mail, which would reveal the survivor’s private health information with potentially violent consequences.
Under the bill, health insurers would be required to offer a confidential communications request form, which allows any insured person to request any medical information sent by an insurer be communicated to an alternate address, secure email address, or alternate phone number designated by that person. In other words, a patient who is not the policyholder can redirect their health information communications to herself or himself and keep it private.
“Ultimately, this bill is about keeping Rhode Islanders safe and eliminating roadblocks that keep people from seeking the treatment they need. Adult children on a parent’s health insurance policy should not have to worry about that information being shared. And no one should be put in danger by having their personal health care information sent to someone with whom they would rather not share it,” said Representative Donovan (D-Dist. 69, Bristol, Portsmouth).
The COVID-19 pandemic exacerbated previously existing public health problems that cause suffering for many Rhode Islanders. Overdose fatalities continue to increase in the state. More young adults are attempting suicide. Domestic violence calls to the statewide helpline have spiked. Sexually transmitted infection rates were increasing pre-pandemic and remain high. Against this backdrop, Rhode Island insurance companies are engaging in practices that unintentionally violate patient privacy, making it harder for people to receive needed health care and access that care safely.
The bill was supported by the Rhode Island Coalition Against Domestic Violence (RICADV) and the Rhode Island Health and Privacy Alliance (RIHPA), a cross-sector, multi-disciplinary coalition that formed in 2018 to prevent EOB-related privacy breaches.
“Access to health services is vital for victims of domestic violence. Unfortunately, many survivors may forego needed medical or mental health attention if their abuser is the policy holder, because they fear their abuser will be alerted to their use of medical services. Abusers are known to interfere with victim’s access to health care and this disclosure from insurance letters could escalate the violence the victim is experiencing. We have seen this consequence firsthand by working with survivors,” said RICADV Director of Policy and Advocacy John Wesley.
Dr. Jack Rusley, Rhode Island physician and co-chairperson of RIHPA, said, “In my experience working with young people in my clinic, many want to take steps toward being healthy — whether it may be engaging with mental health care or taking a medication to prevent HIV — but they decide to forgo these treatments, out of fear their parents would get an EOB. While the stated aim of EOBs is to promote transparency, these letters have unintended consequences that put the patients I work with and many others in a position where they must make an impossible choice. The result is often a delay in care, or avoidance all together. These letters have a chilling effect.”
Dr. Joanna Brown, Rhode Island physician and co-chairperson of RIHPA, said, “I’ve seen young adults afraid to get mental health counseling or STD testing because they weren’t comfortable having their parents find out. The last thing we need right now are barriers to health care, particularly for vulnerable youth. Insurance protocol shouldn’t get in the way of the doctor-patient relationship.”
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