BOSTON, MA – On Feb. 14, Senator Cindy Friedman (D-Arlington) joined her colleagues in passing legislation to protect patients’ access to confidential health care. In an effort to maintain the confidentiality of patients covered as dependents on another person’s insurance policy, the “PATCH Act” requires insurance carriers to issue common summary of payment forms directly to the patient.
“Every Massachusetts resident should have the ability to make confidential health care decisions of their choice,” said Senator Friedman. “Too often, patients are reluctant to get certain treatment services for fear that their personal health information may be shared with a parent or spouse. This bill ensures a patient’s right to privacy and increases access to healthcare for those seeking treatment services that they need.”
Some health insurers’ current billing and claims communication practices can unintentionally violate the basic right to privacy of a patient covered as a dependent on another person’s policy, for example a young adult, minor or spouse. Insurers routinely send summary of payment or Explanation of Benefits (EOB) forms, detailing the type and cost of medical services received, to the primary subscriber on an insurance plan. In many situations, young adults, minors or women may choose to forego certain types of treatment due to fears that a parent or spouse will see sensitive health information on an EOB form.
“Today the Senate has passed a common sense solution to a problem that impacts access to health care for many Massachusetts consumers,” said Amy Rosenthal, Executive Director, Health Care For All. “Currently, Explanation of Benefits notices are sent to the primary policy-holder detailing health services received by a dependent. It is time to better protect privacy so that this doesn’t deter, for example, young adults from seeking sensitive services or worsen the situation for victims of domestic violence. We now urge the House of Representatives to advance An Act to Protect Access to Confidential Healthcare to effectively protect health information from being shared with anyone other than the patient.”
The bill requires the Division of Insurance to develop a common summary of payments form to be used by all insurance carriers in the Commonwealth. Insurers would be required to issue these forms at the member level and allow each insured member to choose their preferred method of receiving the forms.
“We applaud Senate President Chandler, Senator Spilka, and members of the Senate for passing Senate Bill 2296, the PATCH Act, this afternoon. We are pleased to have worked with legislative leaders, Attorney General Maura Healy, the PATCH Alliance, and the Baker Administration on this important piece of legislation,” said Lora Pellegrini, President and CEO of the Massachusetts Association of Health Plans. “The PATCH Act will give health plan members confidence in knowing that they can receive the medical treatment they need, while ensuring that their medical information remains private and will be delivered in a way that best meets their particular needs. The bill requires that Explanation of Benefit forms, commonly referred to as EOBs, be issued at the member rather than subscriber level, allows members to request that EOBs be delivered by mail or electronically, and in some instances, be diverted or suppressed where appropriate. We look forward to working with the House to ensure quick passage of this legislation and look forward to Governor Baker signing the PATCH Act into law.”
The bill requires the Division of Insurance to define sensitive health care services that cannot be identified on the common summary of payments form. Instead, the EOB would provide generic information only, such as “office visit” or “medical care.” Patients who are legally authorized to consent to care would be allowed to request suppression of summary of payment forms for a specific service or procedure if no payment is due.
The bill also requires the Division of Insurance, in consultation with the Department of Public Health, to develop and implement a plan to educate providers and consumers regarding the rights of insured members and responsibilities of carriers to promote compliance.
The bill will now be sent to the House of Representatives for consideration.