After the Appointment

Prescriptions – Pharmacy

Can parents or guardians see what medications were filled if the patient uses their health insurance at the pharmacy?
Answer Insurance Explanation of Benefits (EOBs) are typically sent directly to the policyholder or are available online to the policyholder through insurance portals. These documents can reveal the medication name, date, and pharmacy. This information can inadvertently reveal confidential care to guardians.
What to do
  • Before prescribing, inform the adolescent patients which prescriptions may be visible to a parent or guardian through insurance paperwork.
  • When possible, suggest confidential payment options such as cash or pharmacy discount programs, to avoid EOB disclosures.
  • Ask pharmacy staff about confidential billing, payment, and dispensing options.
Sample script “Some prescriptions might appear on insurance statements that your parent/guardian receives. We can talk about options to pick up medications privately if that’s important to you.”
Does the pharmacy have an electronic system for refills and, if so, who can see the medication and request refills?
Answer Many pharmacies provide refill requests and notifications via online portals. If a parent or guardian manages the account, they may receive alerts and notifications about eligible refills or pending pickups from the pharmacy.
What to do
  • Verify with the pharmacy how adolescent accounts are managed and whether guardians have access.
  • Counsel adolescents on potential disclosure if a guardian is linked to the pharmacy account.
Sample script “Some pharmacies send refill notifications to parents automatically if their account is linked. We can check the pharmacy’s policies to help keep your medications private.”

 

Lab Testing and Results

Who can see lab results, and how are they released?
Answer Lab work and the results may automatically appear in both the adolescent patient’s and proxy portals, depending on the EHR and portal settings. Insurance paperwork, such as EOBs sent to the policyholder, may also disclose sensitive information (e.g., pregnancy, STI, or substance use testing) to parents or guardians. If not handled carefully, lab results and billing information could disclose confidential information even when an adolescent independently consented to care.  
What to do
  • Review your institution’s EHR settings to determine how lab results are released and what lab results are visible on proxy portal accounts.
  • If labs results are automatically released to proxy accounts, determine whether proxy access can be restricted for confidential services.
  • Coordinate with laboratory and medical records staff to develop workflows that protect confidentiality for sensitive testing (e.g., delayed release, confidential flag).
  • Before ordering, tell adolescents which lab results may be visible to parents or guardians through portals or insurance communications.
  • Confirm the adolescent’s preferred communication method for discussing results (e.g., phone call, private portal message) and document them in the chart.
Sample script “Some lab results automatically show up in online accounts or insurance statements that your parent/guardian might see. We can talk about which tests are confidential and how you’d like to get your results.”
How should clinicians discuss lab billing and EOBs with adolescents?
Answer Billing for lab tests often generates claims for the policyholder, listing test names or codes that may identify the service. Even if the test is handled discreetly, insurance paperwork can compromise confidentiality.
What to do
  • Before ordering sensitive tests, explain potential disclosures to adolescents and discuss any available alternative payment options.
  • Help adolescents complete insurance confidentiality request forms (e.g., through the Office of the Insurance Commissioner) to redirect or suppress EOBs.
  • When feasible, offer clinic-funded or grant-supported options to avoid insurance billing for particularly sensitive tests.
Sample script “Sometimes lab tests show up on insurance statements. If you’re worried about privacy, we can go over ways to handle billing more confidentially or use other payment options.”

 

Patient Communication

How can follow-up communication with the patient be managed while protecting confidentiality?
Answer Use only the follow-up communication method the adolescent has identified as private and safe. Avoid sending messages with sensitive information to parents’ or guardians’ emails or phones.
What to do Document the adolescent’s preferred confidential communication method in the chart and consistently use it for follow-up on results, appointments, or treatment questions.

Remind the patient that they can use their patient portal to send private messages to their care providers for any questions or concerns after their visit.
Is the patient’s portal access private and separate from their guardian’s access?
Answer Portal access varies by institution. Some systems allow separate adolescent and proxy accounts with different levels of access, while others do not.
What to do
  • Verify that the adolescent’s portal account is properly configured for private access.
  • Educate both the adolescent and the guardian how patient and proxy accounts differ, and why separate access is important to prevent accidental disclosure.
How would the patient like to be contacted with follow-up questions or results?
Answer Adolescents may prefer different ways to receive follow-up information. Always confirm a method that preserves confidentiality.
What to do Ask the adolescent directly and document their preference—by phone, email, text, or portal notifications. These preferences may change over time, reassess periodically, and update the chart as needed.
Sample script “What is the best way for us to follow up with you about your results or questions? Do you have a private phone number, email, or portal account we can use?”

 

Billing

If a patient requests that their visit or parts of their visit be kept confidential, how can providers bill for services and maintain confidentiality?
Answer Billing for any visit often generates EOBs or statements sent to the insurance policyholder. These documents can inadvertently disclose confidential care. Some institutions have policies or billing codes to minimize disclosure for sensitive adolescent services.
Considerations As a policy, Medicaid/Apple Health and Managed Care Organizations who manage Apple Health do not send out EOBs for health care services provided to teens ages 13–18.
What to do
  • Familiarize yourself with your institution’s and state’s billing confidentiality protections.
  • Use confidential billing codes when they are available.
  • Before billing, discuss potential risks and disclosures with the adolescent.
  • Assist patients with completing health insurance confidentiality forms, such as this Office of the Insurance Commissioner form, and submit them to relevant health insurance companies on behalf of patients.
  • When possible, explore alternative payment options (e.g., confidential payment, sliding scale, clinic-funded care, enroll in Medicaid Family Planning Only program, or refer to the closest Title X Clinic) to protect privacy.
Sample script “Some services might appear on insurance statements your parent/guardian receives. We can review options for confidential billing so your care remains private when possible.”

 

Insurance

What information appears on an EOB?
Answer EOBs typically list the types of services provided, date of service, provider, billing amount, and the insurance coverage applied. They may also include diagnoses and procedure codes, which can reveal the nature of the service.
Who receives the EOB?
Answer EOBs are generally sent to the policyholder—most often a parent or guardian—even if the adolescent consented to care independently.
If a patient requests confidentiality and consents to certain care independently, will an EOB still be sent to their guardian?
Answer In most cases, yes. Even for confidential services, EOBs are sent to the policyholder unless state law or institutional policies allow an exception.
Note Washington Apple Health/Medicaid and Medicaid Managed Care Organizations automatically suppress EOBs and limit quality assurance calls to protect patient confidentiality.
What to do
  • Familiarize yourself with your institution’s and state’s EOB and confidentiality billing riles.
  • Use confidential billing codes when available.
  • Discuss potential risks and disclosures with the adolescent before billing.
  • Assist patients complete health insurance confidentiality forms and submit them to relevant health insurance companies on behalf of patients. For example, this form from the Office of the Insurance Commissioner.
When possible, explore alternative payment options such as confidential payment, sliding scale, clinic-funded care, enrolling in Medicaid Family Planning Only program, or refer to the closest Title X Clinic to protect privacy. to protect patient privacy.
Is there a way for an adolescent patient to request that EOBs be sent directly to them?
Answer Some states and insurance plans allow adolescents to request that EOBs or other confidential communications be sent directly to them. Processes vary by insurer, and EOBs may still be sent to a shared address.
What to do
  • Be aware of local regulations and insurer-specific policies for confidential communications.
  • Give adolescents information to submit requests for direct EOB delivery and discuss alternative payment options when confidentiality is important.
  • If possible, provide patients with a health insurance confidentiality form that they can complete during the appointment and that the clinic can then mail for them. Remind the patient that the form may take several weeks to be processed and may not prevent an EOB being sent for the current appointment. They can complete during the appointment and have the clinic mail for them.
  • Remind patients these forms can take several weeks to process and may not prevent an EOB disclosure for their current appointment. 
Sample script “Some insurance statements might go to your parent/guardian. You may be able to request that they be sent directly to you. We can help you find out what your plan allows and review other options to keep your care private.”

 

Health Information Management (HIM)

If a guardian requests health records, are confidential notes or other private health information for adolescents released?
Answer Release policies vary by state law and institution. Generally, confidential notes related to services that adolescents can consent to independently (e.g., sexual health, mental health, substance use treatment) are not released automatically to guardians. Medical records staff should follow institutional and legal guidelines to protect sensitive adolescent information.
What to do
  • Clinicians and staff should understand which records can be released and under what circumstances.
  • Clearly indicate in the chart which notes or services are confidential, and document when a parent or guardian agreed to private one-on-one conversation with the care provider for their teen.
  • Provide clear information to both adolescents and guardians about information may or may not be released.
Sample script “Some parts of your health record, like notes about confidential services, are protected by law and won’t be shared automatically if a parent or guardian requests your records. We can explain what can be released and what stays private.”

References

Agostino H, Toulany A. Considerations for privacy and confidentiality in adolescent health care service delivery. Paediatr Child Health. 2023;28(3):172-183. 

Chung RJ, Lee JB, Hackell JM, Alderman EM, COMMITTEE ON ADOLESCENCE, COMMITTEE ON PRACTICE & AMBULATORY MEDICINE. (2024). Confidentiality in the care of adolescents: Policy statement. Pediatrics. 2024;153(5).

Confidential Healthcare for Adolescent Minors and Young Adults: A Position Paper of the Society for Adolescent Health and Medicine. Journal of Adolescent Health. 2025; 77(4): 791 – 796

Confidentiality in adolescent health care: ACOG committee opinion, number 803. Obstet Gynecol. 2020;135(4):e171-e177. 

English A. Adolescent & Young Adults Health Care in Washington: A Guide to Understanding Consent & Confidentiality Laws. San Francisco, CA: Adolescent & Young Adult Health National Resource Center; and Chapel Hill, NC: Center for Adolescent Health & the Law, 2019. http://nahic.ucsf.edu/resource_center/confidentiality-guides/

 

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