HIPAA Fail

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Everyone knows what HIPAA is, right?

“Uh, yeah, obvs. It’s that law that means anything and everything about my medical record is totally confidential. I may not know anything about the ACA, because let’s face it, that thing’s completely impenetrable, but I know all about HIPPA. Starting with the fact that you spelled it wrong. Two Ps. Like hippo. I’m pretty sure about that one.”

Okay. First of all, it’s the Health Care Portability and Accountability Act. One P and two As. Check it.

Beyond that, you’re basically right. It does some other stuff that no one ever remembers about not losing your insurance when you change jobs, but mostly it’s about privacy.

Unless you’re a young adult covered by your parents’ health insurance.

Now your chart, the medical record in your health care provider’s office where we write down all the details about your visits and file your lab results and whatnot, IS protected. So when you come see me about starting birth control, our entire convo about how your boyfriend really doesn’t like condoms and you’re afraid you’ll have trouble remembering to take a pill every day and btw there was that oops/hookup with your ex last weekend… all that stays inside the walls of our clinic, unless you specifically request we send it over to someone else.

But as soon as you use your health insurance to pick up the prescription I gave you, or to get the STI test I gently yet firmly recommended (c’mon, you know it was overdue), there’s a chance your parents could find out. Why?  Because of this obnoxious little thing called the Explanation of Benefits.

Here’s what happens: your health insurance provider pays for some sort of service related to your medical care – a lab test, a prescription, an imaging study, a clinical visit, whatever. Then, because the insurance company wants to justify its existence with whoever pays the premium every month, they send that person an EOB to detail all the stuff that they’ve paid for. The EOB doesn’t include test results, but it may include the name of the test performed.

I’ll be honest. I never really look at my EOB. Probably because it looks too much like a bill for my comfort, and bills stress me out, so I usually decide it’s best just to pretend it doesn’t exist. I know. Mature. But say what you will, the decision to ignore that EOB is mine to make. (Before you get all judgey on me, remember: not actually a bill.)

Not everyone is as chill about their EOBs as I am. Let’s say, for example, that you’re an anxious mom of a college freshman. After 18 years of micromanaging every moment of your child’s life, you’re having trouble letting go. You spend your weekends driving to campus and hand-delivering care packages of tissues and snack packs. So when an EOB for services rendered to the youngest enrollee on your family insurance plan arrives in the mail, chances are good you’re going to pay attention. And if that EOB uses words like “CHLAMYDIA/GC DNA PROBE” and “HIV ANTIBODY”, well, now you’re really paying attention. Cue the frantic call to your technically-an-adult child, forcing that awkward conversation that you’ve both been avoiding since s/he was in middle school (and is probably way too late for anyhow).

If you were the timid college freshman with the neurotic mom and you thought there was even a slim chance of this scenario playing out, would you make that appointment? Of course not! Everyone knows your mom is CRAZY. And you know she’ll tell your dad. And then he’ll give you that LOOK when you’re home for Thanksgiving break. Like something fundamental has changed about the way he sees you.

No thanks. Besides, you feel fine, you probably don’t need that STI test anyhow. And condoms aren’t so bad, even if you have trouble using them 100%…70%…50% of the time. Or ever.

See what I’m saying here?  This is a problem.

Keep in mind that because of the ACA, you can now stay on your parents’ plan until you’re 26. Great news for all those recent college grads still looking for a halfway-decent job that comes with benefits, since your parents’ insurance is way better than no insurance at all. And yet: even though you retired your fake ID years ago and can spend your meager entry-level paycheck on overpriced drinks at the bar like the rest of us, your parents still get to know every time a strep test, chest x-ray, or STD TEST is performed.

As you can imagine, your more thoughtful college health providers (AHEM) will have a few workarounds for you: directions to the pharmacies with cheap-o generic pills, negotiated rates for paid-up-front STI tests with the lab company. But not everyone has these options. And remember, these are people WITH INSURANCE – they shouldn’t NEED access to super-low-cost health care services.

The good news is, HIPAA has a way around this, but you have to know about it. And it takes a little effort. But it’s worth it.

What you need to do is call your health insurance company, as well as any health care providers/hospitals/labs where you’ve been receiving care, and ask them to send all the bills and EOBs TO YOU. If the uninformed lady on the other end of the line says she’s not sure she can do that, you just tell her that HIPAA says so. Because it does. (You’re allowed to use a snotty voice here.)

But if you do this, you have be willing to put in a little extra work. You need to remember to call them whenever you change your address, or cell phone number, or email address. Actually setting up your voice mail might be a good idea too. (Just saying.) And you can’t ignore the bills that keep getting sent to you. Even though it sounds like a lot of effort, I promise it’ll be worth it, since it means that you can finally feel comfortable accessing any and all of the health care services that your hefty insurance premiums entitle you to.

And to my fellow college health providers: let’s be proactive about this. Create a policy, handouts, cheat sheet talking points, whatever it takes to make sure our patients are informed about their right to keep their most intimate health care secrets away from their nosy family, so they can get back to using their health insurance to pay for the kind of health care they need the most: contraception and chlamydia tests.

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