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Family Secrets: Adult Children's Health Insurance Claims Can Be Private





You'd think that if you pay for health insurance you'd have a right to know what your plan is paying for. But patient privacy rights can override your desire to know who's claiming what on your health plan.

"Adult children are most certainly worried about this lack of privacy, so much so that it causes many to not seek treatment at all," says Andrew Schrage of Money Crashers. "This can be especially true in cases of substance abuse or contraceptive care."

Children over age 18 who remain on their parents' health insurance plans until age 26 under the Patient Protection and Affordable Care Act have a right to privacy. And even though mom or dad may be footing the insurance premium and even for co-pays or co-insurance, they don't have the right to know what medical services their adult children are seeking. (Parents do have a right to know about the care given to minor children.)

What happens at the doctor's office stays at the doctor's office

"The patient, at the time of seeing the doctor, can request that the information be kept confidential and that the EOB [explanation of benefits] be sent to a different address other than the insured," says Bill Grossmiller, a corporate benefits consultant at Crawford Advisors in Hunt Valley, Md.

But who knows to do that? Most people under age 26 wouldn't even think to request that the doctor protect their privacy or, further, that the health insurance company is obliged to do so. Plus, the staff at the doctor's office probably won't offer that and, of course, things slip through cracks even if requested.

"We've had situations where women have had abortions or miscarriages and didn't get around yet to talking to their parents to drop the news, and through an EOB or other mix up, the parents find out about it," says Grossmiller.

Lay of the law

The HIPAA (Health Insurance Portability and Accountability Act) rules are very clear on this type of information exchange. The patient's desire for privacy is paramount.

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