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What’s Your Son Doing at College? Your Health Insurer May Tell You

One of the most important and well publicized provisions of the Affordable Care Act is the ability to cover adult children until age 26. The Department of Health and Human Services estimates that more than 3 million young adults have been added to their parents’ plans.

Are parents entitled to request information from the insurance company directly as it relates to their adult children?  Absolutely not. Although a parent may have financial responsibility for premiums, this doesn’t translate into access to patient records from a doctor or hospital. A parent will often receive an EOB (explanation of benefits) to clarify a claim, but not be given details as to why a claim was submitted. The  EOB will alert a parent.

HIPPA privacy rules, effective a decade ago, prohibits unauthorized disclosure of medical records and health information. That said, health care providers will still use that information to obtain remaining payments from parents. Although adult children are legally entitled to their privacy and  there are health matters that young adults would like to keep private, that doesn’t always happen.

In addition to HIPPA, there are state laws and insurance contracts that impact privacy. Federal privacy regulations permit a patient to limit to which address the information should be sent. Insurers are required to abide by the patient’s instructions. However, as supervisory practices and guidelines vary, it is hard to say what happens in which state.

If you’ve had an experience with sons and daughters in college, you know what this means. An EOB often has no information and it is very difficult to get the hospital or doctor to tell you what happened. You’ll be forced to get the facts from your child.

Look at your health insurance and see what can be authorized. For more information, contact EAB HealthWorks.