Ralph Sitler III, J.D. -- In the first two installments of this blog series, we covered some fundamental principles that deal with providing care to minors, obtaining appropriate authorization to provide the care, and how to determine who is responsible to pay for the services rendered.  As discussed, it’s not always the parent or guardian of the minor obtaining services.

In general, medical care provided to minors should be authorized by the parent or legal guardian, because minors are not considered competent to enter into legal contracts, and the process of seeking and receiving care does constitute entering into a contract.  When a parent authorizes treatment for their minor child (under 18 years old, in most states) that parent also accepts financial responsibility to pay the bill.  The parent or guardian is also the party bound to make decisions for treatment of health issues, and to whom medical bills and explanation of benefits notifications should be addressed.

There are three exceptions to this rule, though—circumstances under which minors of varying ages are considered competent to seek and authorize their own care, and under which they are considered legally responsible to pay for the care they receive.  They also are entitled to the full benefits of patient privacy privilege when receiving care under any of the three exceptions, so it behooves providers to be aware of these situations to protect both their professional integrity, and their business interests.  Our analysis of these three exceptions to the “Age of Majority Rule” focuses onMichiganlaw, so it is wise to do a little research to discover if the rules are the same in the jurisdiction where you practice.  Of course, you will also want to consult your own licensed healthcare attorney if you are facing a specific set of circumstances.  These articles are a general overview of legislation on the books inMichiganspecifically, and should not be construed or relied upon as legal advice.

The first exception to the Age of Majority Rule, covered in the first article in this series, permits minors to contract for their own care for outpatient mental health care, substance abuse care and prenatal care.  There are age and scope stipulations, though, so be sure you are familiar with the fine print by reading the previous article in this series, or by conferring with your own healthcare attorney.

The second exception discussed deals with the special status afforded emancipated minors, who are considered to be adults for all legal intents and purposes.  Emancipated minors are fully able to enter into contracts, including obtaining medical insurance coverage, and details about treatment should be treated with the same care under HIPAA that would be given to any patient twice their age.  Emancipated minors are also considered to be solely responsible for paying for the care they receive, regardless of its scope or nature.

Exception Three:  Achieving Age of Majority.  When a minor turns 18 and officially becomes an “adult,” a number of variables come into play that providers should take into account when providing care.  For one thing, upon reaching the age of majority, these patients become responsible financially for whatever care they receive.  They may still be on their parents’ insurance until age 26, but any charges over and beyond what insurance covers become the responsibility of the person receiving the care, if they are an adult.  Merely being a policyholder of an insurance plan does not create a financial obligation to pay the portion of the bill not covered by insurance for everyone on the plan.  In spite of this, this does not override the insurance carrier’s obligation to provide explanation of benefits notices to the policyholder, and therefore may serve as reason for providers to caution young adults who prefer to protect their privacy not to seek care that will be paid for by submission of a claim to the carrier.  While it’s true that providers cannot disclose details of the visit to a young adult’s policyholder parent, this prohibition, again, does not extend to the carrier, whose contractual obligation is to the parent.  Because of this, it may be wise for providers to counsel young adult patients on the guidelines in play for protecting their privacy.  Depending on the type of treatment sought, it may be proper to alert young adult patients to the fact that their parents may still have some right to receive some information about their care under the terms of the parents’ insurance policy.

There are many challenges that face teenagers and young adults in our society.  Sometimes, for whatever reason, young people find themselves confronted with circumstances they are not yet prepared to face, looking for guidance, and afraid to deal with consequences of their actions.  Often, it may fall to a long-time family physician to provide advice and support, or a provider may be presented with a patient they have never seen before who believes their situation to be desperate and needing the highest degree of privacy and discretion.  Although legislation currently on the books provides some guidance to providers when treating this category of patient, often the best intentions can be met with unforseen ramifications.  Therefore, you should be prepared in advance for how to deal with the young adult demographic in the most professional and compassionate way possible.  The trick is figuring out how to do this in compliance with the law but without compromising the fiscal health of your business.