By Ralph Sitler III, JD -- It’s important for health care providers to determine how the services rendered will be paid, and who is responsible for payment. Since financial responsibility often falls on a guarantor other than the patient, it can be a can of worms to try to figure out where to send the bill for certain patients under certain circumstances. For example, it can be difficult to assess financial responsibility when treating minors. This is because minors can fall into any of several demographic categories when treatment is sought, and can even authorize their own care in some instances. Because of this situational power to authorize their own care, the parents or guardians of a minor may at times disclaim financial responsibility for services rendered to the child. So if a bill goes unpaid, can you pursue the parent or guardian for payment? Maybe, maybe not.
In this three-part blog series, we will spell out three circumstances under which minors and young adults can authorize their own care, and some things you, as the provider, should do to ensure you’re providing properly authorized care that can be appropriately reimbursed by the appropriate party. Most of what we’ll cover is based on Michiganlaw, though, so you’ll want to be sure to check with your own healthcare attorney if you’re in another state because laws do vary from state to state. Make sure you’re following the rules in the jurisdiction in which you provide services, and avoid getting stuck with a bad debt or worse.
In most instances, minors cannot legally contract for or authorize their own medical care. An individual is considered a minor if he or she has not reached the age of majority (which is 18 in most states), and it is only after reaching the age of majority that individuals are considered to be adults for legal purposes.(1) It is the change in status from minor to adult at age 18 that allows the individual to enter into contracts, including contracts for receiving medical care and the responsibility to pay for such care. On the other hand, minors are not considered competent to make medical decisions for themselves in most instances, leaving the authority to contract for medical care and financial responsibility for that care to their parents or guardians. This is why it’s typical to collect payment for care from the parent or guardian, or to pursue the parent or guardian in cases of non-payment.
In spite of that, there are certain instances in which minors are considered competent to authorize care for themselves before reaching the age of majority. Even though there are only a few exceptions to the age of majority rule, they are important to note not only when obtaining valid authorization for care, but also to ensure fair collection practices, and to avoid HIPAA-related violations.
Exception 1: Outpatient Mental Health Care, Substance Abuse Care and Prenatal Care. In Michigan, a minor 14 years and older may authorize their own mental health care for up to 12 visits or four months, whichever comes first; but self-authorization rights are limited to outpatient care, and do not include the right to obtain prescription medications.(2) On the other hand, a minor of any age can authorize substance abuse care, including inpatient treatment and prescription medication.(3) Similarly, a minor of any age can authorize some reproductive health services on their own, including testing and treatment for sexually transmitted diseases and prenatal care (including inpatient services and prescriptions), but not pregnancy termination services.(4)
However, along with the right to authorize care comes the responsibility to pay for the care. The parent or guardian in these cases is not considered financially responsible for the minor’s care, or for any portion of the fees for care that are not covered by an insurance policy, even if the parent or guardian is the policy holder. The reason for this is two-fold. First, since the parent or guardian did not authorize the care, they cannot be held responsible for paying for that care. Second, it becomes a privacy issue for the minor patient, who may not want their parent to know about the care they are receiving. The provider’s obligation to protect the privacy of a minor can be enforced by the minor under some circumstances, even though there are also circumstances under which it is left to the discretion of the healthcare provider to determine whether a minor’s parents or guardians be notified of treatment the minor has received. In cases where the minor wishes not to have an insurance policy guarantor (parent or guardian) notified of treatment received, it is most effective not to file a claim with the insurance carrier. This is especially true since the insurance carrier’s contractual obligation is to the policy holder, and there is no way a provider can ensure that explanation of benefits notifications will not be supplied to the policy holder, who is also likely to be the parent or guardian of the minor seeking treatment. Also, under no circumstances does a minor’s right to privacy override the provider’s legal obligation to notify parents, guardians, civil authorities or public health agencies when circumstances dictate that such notification must be made. This applies especially to situations wherein the provider suspects the minor patient may have been physically or sexually abused, when the minor has indicated a predisposition to injure him- or herself or others, or when the public health or safety may be endangered as a result of non-notification.(5)
Following state and federal laws will ensure you don’t wind up in a predicament for having provided treatment to a minor without the proper authorization, whether that comes from the minor or the minor’s parents. In the next installment, we will cover another exception to the age of majority rule: Emancipated Minors. Please watch for notification when that installment goes online.
(1) Age of Majority Act, MCL 722.52
(2) Mental Health Code, MCL 333.1707
(3) Public Health Code, MCL 333.6121
(4) Public Health Code, MCL 333.9132
(5) Child Protection Law, MCL 722.62 et seq.
