Confidentiality, Third-Party Billing, & the Insurance Claims Process: Implications for Title X, Abigail English, Robin Summers, Julie Lewis, and Clare Coleman, The National Family Planning & Reproductive Health Association (NFPRHA) (2015)

The National Family Planning & Reproductive Health Association (NFPRHA) issued this important white paper to address a complex question of major current concern - how to provide confidential health care services for individuals with health insurance without either sacrificing confidentiality protections or forfeiting insurance coverage. The white paper provides background on the importance of confidentiality in family planning settings, the role of Title X, and the health care delivery environment, particularly as a result of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and the Affordable Care Act (ACA).

Federal and state laws contain numerous confidentiality protections which vary widely in terms of what information they protect, who can access that information, when the patient’s permission is required for disclosure, and many other factors. This white paper discusses disclosure requirements and confidentiality protections in the HIPAA Privacy Rule and state medical privacy laws as well as in the laws related to the primary sources of revenue for Title X-funded health centers—the Ryan White HIV/AIDS Program, Section 330 Federally Qualified Health Centers (FQHCs) program, Medicaid, and commercial health insurance. The white paper also highlights examples of targeted approaches in several states that may provide confidentiality protection in the billing and health insurance claims process, including both laws and policies that are already on the books and new pending legislation.