If you're under the age of 26 and have a parent or legal guardian who has health insurance for dependents, you may be added to their plan. This can assist you in controlling healthcare costs.
However, it can generate issues regarding privacy and confidentiality, particularly among LGBTQIA+ individuals.
"Many young adults in the United States are covered by their parent's insurance until they turn 26, so they aren't the ones receiving the insurance bill or records," says Lindsey Schafer, a licensed social worker and mental health therapist specializing in sex and sexuality at Wise Therapy Associates in New York City.
Those insurance health records are delivered directly to their parent's homes or to their guardians' email inboxes shortly after doctor's appointments.
"Because they don't have control of those insurance records," she adds, "it's pushed some of the people I work with to come out to their parents and families before they're ready."
Many young people in this scenario, understandably, maybe at a loss for what to do. Continue reading to discover more about your rights as an insurance dependent and privacy strategies when accessing LGBTQIA+ affirming health care.
In the United States, the Health Insurance Portability and Accountability Act (HIPAA) went into effect in 1996. This federal statute established guidelines for safeguarding the privacy of personal health information.
Only few circumstances are allowed under the HIPAA Privacy Rule for a healthcare practitioner or insurance to divulge a patient's health information without their consent. One of these circumstances is when you're looking for money.
This means that your doctor can tell your insurance company about your medical history. As a result, each time you utilize a health service, your insurance provider can share your records with the insurance holder.
This policyholder is your parent or guardian if you're dependent on a health insurance plan.
"As a healthcare worker, HIPAA protects my patients by requiring me to obtain specific authorization from the patient before discussing medical matters with friends or family," explains Bethany Malone, MD, a surgeon in Forth Worth, Texas.
"While this safeguards the doctor-patient relationship, there are alternative ways for the primary insurance holder to learn about sensitive healthcare issues." "This happens in the form of an explanation of benefits (EOB), which is a document sent out by the insurance company that explains what healthcare has been delivered and invoiced to insurance," she says.
If you're a dependant on a parent's or guardian's insurance plan, your insurer may send or send electronically a copy of your EOB to your caregiver. They may also receive bills for services from your doctor or other healthcare providers.
You may be hesitant to seek health services if you haven't discussed your gender or sexuality with your parent or guardian, or if you don't want them to know that you've used them.
In a 2019 study, for example, researchers discovered that young adults were less willing to take preexposure prophylaxis (PrEP) if they didn't want their parents to know. This drug reduces your chances of developing HIV.
Despite the fact that HIV can infect persons of any gender or sexuality, it is more common in transgender women and men who have sex with males.
"It raises a significant question if young adults aren't already having these dialogues with their parents or guardians," Schafer adds. "'Can I obtain sexuality- or gender-affirming treatment that will help me live my best life as the person I identify as, or am I going to put it off because I'm not ready to come out?"
HIPAA isn't the sole law that governs the exchange of personal health information.
Several states have enacted extra legislation to safeguard the privacy of health insurance dependents. Some states, for example:
- Allow insurance dependents to submit a written request for confidential communications to their insurance provider.
- Allow insurance companies to send EOBs to patients instead of policyholders, or only send EOBs when payment is due.
- maintain the privacy of family members seeking treatment for sexually transmitted infections (STIs)
- These safeguards may only apply to adult dependents in specific instances. They also apply to juveniles in some instances. The kind of health services protected by these safeguards differ by state.
Check out this table to see if your state has developed insurance-dependent confidentiality provisions. Keep in mind that this information is subject to change.
To discover more about current rules and practices in your state, speak with your doctor or insurance provider. For more information on sexual and reproductive rights policy decisions, visit the Guttmacher Institute's website.
How do you deal with concerns about insurance-related privacy?
Take these steps into consideration.
Prepare for your appointments by reading up on the subject.
It's critical to understand what information your healthcare team and insurance will share — and with whom — in order to make informed decisions regarding your healthcare use and privacy.
"I believe it's extremely important to know what to expect so there are no surprises," Schafer says. "Have this chat with your doctors before you even go into their office so you know what's going to be delivered to your house or guardians ahead of time."
She adds, "Ask them if there are any other ways to report that billing information." "Doctors can sometimes send a bill that is less explicit, a little more discreet, or confidential."
You can contact your insurance provider to learn more about their confidentiality policies and practices, in addition to speaking with your doctor and other members of your care team.
Be prepared for difficult discussions.
In some situations, you may choose to use health services even if this implies that information about those services will be given to a parent or guardian.
Schafer advises people to anticipate any questions that may arise at home as a result of this.
"If you go ahead with it, be aware that this may be a talk you'll have to have with your family or the folks who will be receiving these bills," she advises.
"The sad reality is that many members of the LGBTQIA+ community live in circumstances that are homophobic and transphobic. If you find yourself in this circumstance,
If you have to come out, explain a bill, or deal with a scenario like this, make sure you have a safe environment, as well as people and resources to lean on," she advises.
Consider purchasing your own insurance policy.
If you can afford it, you should consider dropping out of your guardian's insurance plan and enrolling in one of your own. All of your insurance records will be given to you directly in this manner.
Before you sign up for a plan, find out what services it includes. Every health service is not covered by a single plan. Even if a service is covered, you may be required to meet certain criteria or take specific measures in order to be reimbursed.
Look for a plan that covers transition-related therapies like hormone therapy or sex-affirming surgery, for example. Examine the insurance policy contract for a list of coverage exclusions and contact the insurance provider for more information.
Prepare yourself for questioning from your parents or guardians regarding your decision to leave their insurance and join your own.
Look for health services that are free or low-cost.
You may have to pay the whole cost of services out of pocket if you don't have health insurance or if you can't claim specific services on your insurance. In some situations, though, you may be eligible for low-cost or no-cost health care. Here are several examples:
- Counseling and therapy are two different things. Some mental health counselors offer sliding-scale counseling, which means they charge varying prices depending on a person's income or financial situation. A therapist in training at a university is another option. They're a good choice for free or low-cost help, and they're supervised by licensed specialists.
- Support in times of need and access to the community. The Trevor Project, a nonprofit organization that provides mental health care to LGBTQIA+ community members, offers free and confidential support from a crisis counselor.
- Care that is gender-affirming. The National Center for Transgender Equality provides resources and advice to assist transgender people in understanding their health rights, obtaining insurance, and obtaining transition-related financial assistance.Prescriptions and general care
- Prescriptions and general care Visit the National Association of Free & Charitable Clinics to identify clinics and pharmacies that give free or low-cost care to the uninsured and underinsured.
Pregnancy tests and services, as well as STI testing.
To find HIV care and support programs or to apply for financial assistance for HIV drugs, go to the Health Resources and Services Administration Ryan White HIV/AIDS Program.
To see if you're eligible for free PrEP medicine, go to the Ready, Set, PrEP website. The National Alliance of State and Territorial AIDS Directors (NASTAD) also has information on state-based PrEP programs.
Find PrEP providers, HIV testing and treatment programs, and information on health insurance alternatives in your state by searching the Greater Than AIDS online database. It's crucial to realize that if you're an LGBTQIA+ health insurance dependant, your parent or guardian may receive information about the health treatments you use.
Some states have implemented laws to protect the privacy of insurance dependents, but these laws differ from one state to the next and from one case to the next.
To find out what protections are available to you and what information your parent or guardian might obtain, speak with your doctor and contact your insurance provider. Be prepared for the talks that may arise if you opt to use sensitive health services.
It may be appropriate for you to enroll in your own insurance plan or seek out economical health services that are not covered by insurance.
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