'I Can't Tell You That'—Five Words You Never Want to Hear from Your Health Plan

People often hate dealing with their health plans. I help them do just that for a living, so I see it up close. When I help clients on family plans, I often find that people overlook their plan role and permissions. Consider:

1. You’re blocked from your teenager’s health information.

2. You’re the family planner, but your insurer won’t let you complete an important task.

3. You’re caregiving for an elderly parent or relative, but can’t access their critical information in a pinch.

All avoidable problems!

First, here are three roles to understand:

Subscriber is the "owner" of the policy. This is usually the person who signs up for the plan through an employer or marketplace. Your doctor’s office often wants to know who the subscriber on your plan is.

Dependents are other people on the plan. Spouses may be labelled “Spouse / Partner”, but they are dependents if they are not the subscriber. Children are dependents too.

An Authorized Representative is a person or organization you choose to act on your behalf. They do not have to be on your plan.

Which one are you? If you don’t know, check your member portal. Your ID card and Explanation of Benefits documents may not have this information. (Register for your portal if you have not already done so and get the app on your phone. This will take less time than calling). Examples:

• If you acquired your health plan through your employer, then you’re the subscriber.

• If you are the one who signed everyone up on a marketplace, then you are likely the subscriber (but double check).

• If you are 26 or younger and on your parent’s plan, you are a dependent

Let’s go back to the scenarios above:

1. You’re blocked from your teenager’s health information.

Once your child turns 13, you still have automatic permission to basic access but may need permission for certain info. Think sensitive information like reproductive or mental health. Look up the particulars in your state or ask your plan. And once your child is 18, you need permission for even basic information. They can grant you access for all information. Your plan may require you to complete a form to do so.

Becoming a health proxy for your 18+ child is a good idea to prepare for medical emergencies. Though your 18+ child can verbally allow medical providers to disclose information to you or sign a HIPAA permission form at a hospital, imagine the worst case scenario that they are physically unable to do so and you are shut out of managing your child's care.

2. You’re the family planner, but your insurer won’t let you complete an important task.

Let’s say billing information needs updating because you received your new credit card. Only the subscriber can do this. Or, more critically, it’s enrollment time and you’re down to the last minute and your spouse, the subscriber, is out-of-town.

These vary by plan; checking ahead of time is the best bet.

3. You’re a caregiver of an elderly parent or relative, but can’t access their critical information in a pinch.

This is where the Authorized Representative comes in. Your loved one can grant you full access as an Authorized Representative. Get the from your health plan, then have your parent or relative sign it. Again, we don't want to imagine worst case scenarios, but best to take care of this before a loved one is unable to do so. Note that health plans require these to be re-authorized, typically after one year.

By the way, one member can temporarily and immediately grant permission to receive information and to act on their behalf even if the right form or process was previously completed. Both of you call the health plan, explain yourself to the agent, and the agent will ask the member if they authorize you. This permission lasts only as long as the phone call. So while helpful, do not depend on this method because logistics can easily break down e.g availability, call quality.

There’s more to this, but you see the theme is planning ahead. Taking a few minutes now to understand your role on your health plan can avoid heartache down the road. Whether you're trying to view a claim, update coverage, or help a family member, knowing what permissions you have and what you might need to request makes navigating your health insurance smoother.

Please reach out for assistance if needed.