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Opinion >  Column

Sue Lani Madsen: The ultimate surprise medical bill

Sue Lani Madsen, an architect and rancher, writes a weekly column. (Jesse Tinsley / The Spokesman-Review)
Sue Lani Madsen, an architect and rancher, writes a weekly column. (Jesse Tinsley / The Spokesman-Review)

As of Jan. 1, teenagers who have to be reminded to feed the dog and take out the trash are in charge of their own health care when it comes to sensitive matters. But parents are still responsible for the bills.

That’s a result of Senate Bill 5889, which adds more legislative bricks to the increasingly bureaucratic walls dividing parents and children in Washington.

Reactions from surprised parents have been flying around social media after notifications went out from insurance carriers. As one mother said, “I love my 13-year-old son. He is smart, compassionate and responsible for his age. He is not however ready to make his own medical decisions without assistance. We’re still working on doing laundry and cooking meals unassisted!”

The bill title is a rather bland “Concerning insurance communications confidentiality.” It had no Republican support. Every Democrat voted yes.

It goes beyond allowing minors to seek confidential treatment and directs insurance companies to send all correspondence, including Explanation of Benefit forms, directly to the minor patient. Parents are prohibited from receiving anything from an insurance carrier that might give them a clue as to why their dependent child visited a doctor.

It won’t protect a struggling adolescent from a wrathful response by a parent. The insurance company will pay their portion directly to the health care provider, but that still leaves the copay and deductibles. Custodial parents are responsible for paying bills incurred by their minor children. Conversations about sensitive subjects that start with “Hey, Dad, I went to the doctor, they want you to pay” will not end well. It’s the ultimate surprise medical bill.

Parents started receiving letters outlining the new rules at the beginning of the year. Thirteen- to 17-year-olds can self-diagnose and seek care related to substance abuse disorder, sexually transmitted diseases, reproductive health (including abortion), mental health (including gender dysphoria and gender-affirming care), and domestic violence without the knowledge, authorization or involvement of their parents or guardians.

Minors already can seek confidential care, which addresses safe access to care in those cases where dysfunctional parents are part of the problem.

“These protections have existed under state law for decades and this bill simply closed a loophole to make sure insurance carriers don’t accidentally release confidential information,” said Sen. Andy Billig, a Spokane Democrat. “These laws help ensure that everyone who needs care is comfortable seeking it even in sensitive situations.”

But SB 5889 goes beyond allowing for confidentiality when necessary to requiring it as the default. It assumes parents are incompetent until proved otherwise, a theme that causes conservatives to grit their teeth. Under 18 is still too young to get your ears pierced without a parent or guardian present, and the solution is not to lower the age for piercings and tattoos. The solution is to integrate families into treatment, especially for mental health care.

Sen. Manka Dhingra, a Democrat from Redmond and chair of the Senate Behavioral Health Subcommittee, sponsored SB 5889 last February, cutting parents further out of the loop. Then in her own newsletter last April discussing House Bill 1874 to support parent-initiated mental health treatment for adolescents, Dhingra said “by centering families in the treatment process, we will be removing barriers to access and eliminating stigma.”

That’s some seriously inconsistent legislating.

Unlike SB 5889, which passed on a strictly party line vote, there was strong bipartisan support for HB 1874 reinforcing a holistic approach to mental health care. Bipartisanship is usually a sign of better legislation, especially when wading into sensitive subjects. Improving and expanding mental health care is a bipartisan concern. The politically partisan subjects are birth control, hormone treatments for gender dysphoria, and abortion.

When the Washington Legislature reports for duty on Monday, the Democrats might want to set aside partisanship and reconsider. For families with good communication, SB 5889 merely adds yet another patient privacy form to be skimmed, signed and filed every two years to keep parents appropriately in the process. For kids seeking confidential treatment and using their parents’ insurance, it will set them up for confrontation.

If you’re under 18, you can’t legally sign a financial responsibility agreement. Neighborhood snow shoveling jobs aren’t going to cover deductibles, copays and prescriptions. Health care providers, clinics, counselors and pharmacies can’t bill someone who isn’t old enough to sign a contract. After insurance pays its share, parents will have to be billed. Health care providers are required by law to provide itemized statements when there is a balance left after insurance. It’s all part of state and federal government initiatives to introduce cost transparency in health care.

Bye bye, confidentiality.

Setting aside the partisan undertones and absurd billing dilemmas, passing SB 5889 into law has reinforced stigmas surrounding mental health care and weakens instead of strengthens families by teaching it is necessary to keep secrets. And for anyone struggling with a mental illness, strengthening ties to family and community is critical to successfully living a healthy life. No secrets. No surprises.

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