Trying to understand health insurance can be like learning a foreign language that might cost you a boatload of money if anything gets lost in translation. But here’s one clear health insurance fact: The Affordable Care Act allows young adults to stay on a parent or guardian’s job- or marketplace-provided insurance until they are 26. This is excellent.
However, if you’re on a parent or guardian’s insurance and trying to look after your sexual and reproductive health, this setup can give rise to some pretty pressing questions. The reality is that you may not want a parent or guardian to find out if you’re in need of something like birth control or a test for sexually transmitted infections unless they happen to be extremely cool about these things. (But maybe not even then.)
That doesn’t need to stop you from taking care of your sexual and reproductive health, which is a great habit to get into for life. Read on to learn about how to maintain your privacy while accessing services like birth control and STI testing even if you’re on someone else’s insurance.
The main reason why it’s tricky to keep health care appointments confidential when you use insurance is a piece of paperwork called the Explanation of Benefits (EOB).
Due to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), insurers are allowed to disclose health information without your permission in order to receive payment. So, whenever you visit a health care provider and use insurance for payment, the insurer will send an EOB in the mail or digitally about that claim and how much of the claim you’re responsible for paying. Details included on EOBs can vary by insurance plan, but they often include an itemized list of the services rendered.
If you’re worried about what your EOB will look like, some health insurance companies will have a sample one on your online patient portal, Alison Macklin, vice president of education and innovation at Planned Parenthood of the Rocky Mountains, tells SELF. If you don’t see one there, you can always call your insurer and ask if EOBs are itemized. There’s not a 100 percent guarantee that you’ll receive valid information—who hasn’t spoken to a company representative and gotten incorrect intel?—but it’s better than nothing.
Unless you do this type of research, it’s almost impossible to predict how much (or how little) your information will be protected once a health care claim gets sent to your insurance company, Jenn Rogers, M.P.H., co-director of the National Coalition for Sexual Health, tells SELF. Rogers co-wrote the 2017 research report Affordable Care Act and Title X Family Planning Services: How the Changing Healthcare Landscape Has Affected Service Use and Billing Practices, which examined how confidential health services are in 10 U.S. states.
Ask your provider or your insurance company if you live in a state with any laws that would require them to keep your EOB confidential.
Some states have enacted laws to offer more confidentiality when it comes to “sensitive” medical matters. For instance, California’s Confidentiality of Medical Information Act, passed in 2013, requires that health insurers send EOBs for “sensitive” health issues to an alternate address or email address if a patient requests as much. They must also do this if the patient says that the disclosure of this information could endanger them.
What counts as a “sensitive” health issue? California’s law encompasses mental health treatment or counseling services, pregnancy prevention, treatment for sexually transmitted infections, counseling and treatment for a substance use disorder, and more. This law generally extends to people age 12 and above.
Many other states, including Colorado, Maryland, Oregon, New York, Texas, and Washington have passed similar legislation, according to a 2016 report in the American Medical Association’s Journal of Ethics. The details surrounding this kind of legislature vary from state to state.
Some states also have protections in place for young people on Medicaid managed health care plans. For instance, a 2016 New York statute requires that Medicaid managed care plans suppress all EOBs for minors who have consented to their own health care. In Illinois, a 2015 law prevents Medicaid from sending EOBs for services like family planning.
No matter where you live, Rogers emphasizes that you’ll have to do the legwork to figure out the relevant laws and have your insurance provider get any paperwork like an EOB rerouted or suppressed. “The onus is on the patient to do that,” she says. You should do this as soon as possible after a medical visit or even before, if possible, since waiting just a few days can allow time for the EOB to be drafted and sent out.
And don’t forget to ask your provider or insurance representative what information will show up in the online portal.
This is one more way your parent or guardian may be able to see what services you obtained at the doctor. Most insurance companies allow those they insure to log in and review all of their health insurance information online. Different health plans handle this in different ways, according to the report Rogers co-wrote.
Many health insurance companies will automatically connect a minor’s portal to the policyholder’s, which can allow the policyholder to view all of the minor’s claims. However, some plans will change this if a minor calls and requests confidentiality. Either way, insurers typically separate the portals when the minor turns 18, the report says. The only way you can know how your insurer handles it is to call and ask.
If your medical visit results in any kind of prescription, talk to your doctor about the implications of that.
When you’re a minor on your parent or guardian’s health insurance, your parent or guardian is allowed to authorize the pharmacy to share your health information with them, according to HIPAA. For instance, they may be able to get text alerts whenever you have a new prescription ready or be able to view your prescriptions in their online account with the pharmacy. Even if you’re 18 or over but using a parent or guardian’s insurance for prescription purchases, they’ll be able to see the claim in their online health insurance portal (or call the company and ask about recent claims). Then, if your parent or guardian knows the name of the medication, they can look it up to see what it’s used for.
So, if you’re concerned about a medication showing up your parent or guardian’s policy, it might be helpful to talk about this with your doctor so that they can help you understand exactly what information will show up—and what that means. With something like birth control, the intended use is pretty clear, though it’s possible you could tell your parents you’re using it to regulate your periods or deal with hormonal acne. But let’s say you’re prescribed something like azithromycin for an STI like chlamydia. Since this antibiotic can also be used to treat health problems like ear infections, you may be able to blame it on that.
In reality, if a parent or guardian already suspects that you’re sexually active, sputtering about needing an antibiotic for a sudden ear infection you’ve never mentioned before might make them even more suspicious. In an ideal world, you would have been able to share with them when you were first interested in having sex, that you had it, and that you contracted an STI, the condom broke, or what have you. But if you’re here reading this, you probably don’t feel you can have those types of conversations with your parent or guardian. To be clear, we’re not condoning lying about prescriptions or your health. But if you view it as the only way to stay physically or emotionally safe in this situation, you should really think about the logistics so you’re prepared.
If you’re really worried about a parent or guardian finding out that you’re seeking birth control or STI testing, your best bet is not to use your insurance at all.
In that case, publicly-funded health clinics are the way to go. These clinics are also known as Title X clinics because they get much of their funding from a federal grant program dedicated to providing family planning and related preventive health services at little or no cost. Title X clinics do this by using a sliding scale to determine how much you should pay for services based on your income, and they must provide care whether or not you can pay.
“We encourage teens [and young adults] to be advocates for themselves,” Macklin says. “Be honest and talk to a provider about concerns about money; they’ll often have funds that can help offset the costs. And some clinics will offer these services for free.”
Chances are your local health clinic or Planned Parenthood is a Title X grantee. To find the closest Title X clinic to you, enter your zip code at the website for the Office of Population Affairs. (Keep your search history in mind if you share a computer with anyone in your family or if you think your parent or guardian might look at your phone or computer’s browsing logs.)
Another bonus: Some Planned Parenthood clinics also carry certain generic prescriptions, so you may be able to get one filled right there that same day. “That can be appealing for young people who need a one-stop shop,” Macklin says.
Bottom line: Don’t let stigma and fear stop you from getting the care you need.
“There are people who want to help, there are health clinics that want to provide this care to young people,” Macklin says. “Seek them out.”