# Confidentiality in use of health insurance coverage for reproductive health services

> **NIH NIH R21** · BRIGHAM AND WOMEN'S HOSPITAL · 2024 · $495,307

## Abstract

Enhancing Policy Impact for Reproductive Health Equity (EnPIRHE)
Project Summary/Abstract- 30 lines
The World Health Organization affirms that sexual and reproductive health (SRH) services are integral to the
wellbeing and flourishing of individuals and communities. However, societal dynamics of power and oppression
pattern access to these services, presenting disproportionate barriers to younger people, individuals who identify
as Black, Indigenous, and people of color (BIPOC individuals), those with disabilities and chronic disease,
individuals who are transgender or gender-nonconforming (TGNC individuals), and people of lower
socioeconomic status. One exacerbating factor for these health inequities is the social stigmatization of sexuality,
which compels individuals to keep their utilization of SRH services private for fear of negative repercussions,
particularly for people who hold minoritized identities. In the United States, one major threat to patient privacy is
the paper trail associated with utilization of health insurance. Health insurance billing and claims processing for
commercial insurance plans frequently involve sending an “explanation of benefits” (EOB) to the primary
subscriber of the health insurance plan whenever services are provided to any covered family member. When a
person is covered by a parent’s or spouse’s insurance, EOBs are often sent to the primary subscriber, thereby
breaching the person’s confidential health information. Concerns about confidentiality related to insurance billing
can also compound existing barriers to care faced by multiply marginalized persons. Thus, leading health care
organizations have called for policy change to correct this gap in patient confidentiality, and state governments
are increasingly interested in policy solutions to protect individuals’ privacy when using insurance for sensitive
services. Massachusetts is one of only seven states that has enacted legislation (the PATCH law) to protect
confidential use of health insurance coverage, and one of only five that extends such protections to commercially
insured people of all ages, providing a rare opportunity to understand individuals’ utilization of, knowledge of,
and attitudes toward such policy protections. How this novel policy intervention has affected individuals’ attitudes
towards and ability to utilize insurance for sensitive health services has not been studied. We propose to fill this
critical gap in the literature through a mixed-methods study that will directly query SRH service users on their
knowledge of, attitudes towards, and intention to use the protections of the PATCH law. This novel inquiry will
be grounded in an intersectional framework, will engage a diverse statewide patient population, and will use a
mixed methods approach including survey data and qualitative interviews to understand barriers to insurance
utilization, with the goal of improving future health policy interventions.

## Key facts

- **NIH application ID:** 10952740
- **Project number:** 1R21HD116080-01
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Elizabeth Janiak
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $495,307
- **Award type:** 1
- **Project period:** 2024-09-18 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10952740

## Citation

> US National Institutes of Health, RePORTER application 10952740, Confidentiality in use of health insurance coverage for reproductive health services (1R21HD116080-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10952740. Licensed CC0.

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