Barriers and Solutions to Commercially-Insured Adolescents Accessing Confidential Sexual Health Services

Background: All U.S. states provide minors legal rights to consent for confidential sexual health services.  However, federal and state insurance regulations mandate commercial health plans to provide subscribers explanation of benefits (EOBs) containing date, cost and services received which may discourage minors from accessing confidential health services.

Objectives: To explore community providers' perceptions of health systems barriers and suggested solutions for providing confidential sexual heath care for commercially-insured adolescents. Findings were presented to local health plan representatives to initiate dialogue for change.

Methods: We conducted 6 focus groups and 2 personal interviews with 42 Western New York community providers. All sessions were recorded and transcribed. Content analysis was conducted; key phrases identified and main themes emerged.

Results: Barriers identified: 1. Patient costs; 2. Insufficient reimbursement for time and confidential care billing challenges; 3. Confidential communication challenges; 4. Office structure and staff not adolescent-friendly; 5. Unclear laws regarding minor’s right to consent and provider reporting obligations; 6. Rapidly changing clinical guidelines; 7. No community mental health or social services linkages; and 8. Laboratory communications, billing and patient fees. Proposed solutions identified: 1. Systematically include sexual health screening in routine preventive health visit; 2. Suppress EOBs with new confidentiality billing code; 3. Develop standard adolescent communication systems; 4. Provide teens, parents, providers and office staff enhanced education; 5. Use of technology and tools to assist confidential health care delivery; 6. Establish formal partnerships with medical offices, community organizations, health plans and laboratories.

Conclusions: Numerous health systems barriers to providing confidential adolescent sexual health services exist. Some solutions are easily implemented, while others requiring intensive collaboration with health plans and legal systems present challenges.

Implications for Programs, Policy, and/or Research: Addressing challenges to providing confidential sexual health care will affect adolescents accessing care, quality of care, and their relationship with a primary care provider.