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Birth Control and the Insurance Conundrum

January 4, 2010

A physical  with my  pediatrician has been an annual ritual, a pit stop on the rounds of get-this-done-while-you’re-home-from-college before I head back to Rice from winter vacation.  And yes, I still go to the pediatrician I went to when I was a wee little thing, so I wait in the waiting room, next to a box of sample diapers, the game with the colored blocks, 5 year olds and mothers who look only a couple years older than me. But at least this is probably the last time I will be here: I am getting booted off my family’s insurance plan once I graduate, and I am finally too old to keep seeing a pediatrician. This means that these past few years have put me in something of a a nebulous limbo with regards to my ownership of  both the price of my health (fortunately, I haven’t yet had to put up with co-pays and deductibles) and the confidentiality of my health records. This second item brings me to the prickly subject, as acknowledged by my doctor, of privacy rules.

In 1996, the  US Department of Health and Human Services created the  Health Insurance Portability and Accountability Act, commonly referred to as HIPAA.  The main purpose of this policy was to give  individuals the right to their health information and the right to control who has access to it.  Thus, the idea of doctor- patient trust and patient confidentiality gained the legitimacy of law. But what about the age group between 18-22: college aged adults who are still under their parent’s plan? How can you protect the privacy of these individuals’ information while they still share insurance? The HIPAA covers this with respect to providers ( i.e.,  my doctor) but not my insurer:

If I do not object, can my health care provider share or discuss my health information with my family, friends, or others involved in my care or payment for my care? Yes. As long as you do not object, your health care provider is allowed to share or discuss your health information with your family, friends, or others involved in your care or payment for your care. Your provider may ask your permission, may tell you he or she plans to discuss the information and give you an opportunity to object, or may decide, using his or her professional judgment, that you do not object.

My doctor didn’t have any clear cut answer other than to help manuever me through the process of getting birth control without  (fingers crossed) letting my parents know. This process included signing new forms of disclosure that only listed myself and the agreement that should my parents ask, I was getting this prescription because I was having irregular periods.  Admittedly, it’s strange that the doctor should have to essentially lie to the parents, but just because I decided not to disclose my medical records through the doctor’s office didn’t mean that my insurance wasn’t going to let my parents know when I filled the prescription. And then, well– then I would have some explaining to do.

It is true that I could avoid this little ruse  and simply buy contraception on my own from Planned Parenthood, but that would run me between $20 to $30 a month, which means $240- $360 a year! Versus: free.  I imagine many other college aged women, when faced with this steep price or privacy issue, might forgo birth control all together– and that is just women who are already comfortable enough with their sexuality to get to this step. With this high barrier to entry, it’s no wonder that many women go without this safety net. 

Don’t get me wrong, condoms are fantastic and should be used at least as a bare minimum of protection, but do you really want to have to worry, what if it breaks? what if…? In a telling conclusion to my trip to the doctor, a nurse who was administering a shot asked me about my post-college plans. After telling her I wanted to get another degree, she told me that she wished she had gotten her Masters, but now doesnt have the time to anymore.  I asked her why she didn’t: turns out, she took a year off after college, planning on going for the degree after the break…and during the break, she had a child. Unplanned. No more Masters degree. Obviously, this nurse is a smart cookie (she is a nurse after all).  She told me that after her first child, she went on birth control. 

My point is that HIPAA should provide a provision to let individuals specify access rights not only through the provider but through the insurer as well. Also,  we should work to make birth control more affordable, considering it is a long-term-use item– and less stigmatized.  If society has the tools to enable individuals to be in control of their life plans, they shouldnt be subject to taboo, a scarlet letter with which all sorts of assumptions and prejudices are bundled, but rather embraced as the gifts of modern achievement that they are.

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