Key Points

• Privacy concerns about health information can be important for individuals of both genders in diverse life circumstances. Confidentiality can be a factor when individuals are seeking a broad range of health care services, including substance abuse treatment, mental health care or services related to intimate partner violence. Privacy issues may be particularly acute for individuals seeking sexual and reproductive health care, including contraception, pregnancyrelated care, and testing and treatment for STIs, including HIV.

• Despite widespread recognition of the importance of maintaining patient confidentiality, billing and insurance claims-processing procedures widely used in private health insurance today— most notably, the practice of sending explanation of benefits forms (EOBs) to a policyholder whenever care is provided under his or her policy—routinely violate confidentiality for anyone, often a minor or a young adult, insured as a dependent.

• This report reviews state-level legal requirements related to confidentiality in private insurance. It assesses state statutes and regulations that can have the effect of abrogating confidentiality through a number of different avenues and examines steps some states have taken to protect confidential access to care for individuals insured as dependents.

• Laws in almost all states can preclude confidentiality for dependents. About half the states either require or presume the sending of an EOB. Legal requirements often affect broader claims-processing procedures, with virtually all states requiring notices when claims are denied and many addressing issues that arise in the context of divorce and child custody.

• At least eight states have adopted statutes or regulations that could provide a starting point for giving dependents the confidentiality protection they need. However, it is important that the extent to which these existing policies protect confidentiality in actual practice be fully investigated before they are looked to as approaches that might be adopted more broadly.