title: Screening trauma patients for alcohol problems: are insurance companies barriers?
abstract: BACKGROUND
  Impairment caused by alcohol is the leading risk factor for trauma. However, many physicians do not screen for alcohol use because of concerns about confidentiality and denial of insurance coverage. The purpose of this study was to examine objectively the confidentiality issues and insurance statutes affecting alcohol screening in trauma centers.
  
  
  METHODS
  We conducted a survey of insurance commissioners in all 50 states to determine the prevalence of statutes allowing denial of coverage for injuries sustained while impaired due to alcohol, reviewed state insurance laws, and reviewed federal regulations protecting the confidentiality of alcohol information in patients seeking alcohol treatment.
  
  
  RESULTS
  Special federal regulations protecting confidentiality of alcohol screening data depend on how such information is acquired and do not routinely cover trauma patients. Concerns about screening on insurance coverage are valid in 38 states.
  
  
  CONCLUSIONS
  Segregating information about alcohol use in the medical record and assigning designated chemical dependency counselors to screen all trauma patients would provide confidentiality of alcohol information under current federal regulations, allowing denial of release of such information, except under subpoena.
authors.affiliation: Harborview Injury Prevention and Research Center, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
authors.forename: F P
authors.initials: FP
authors.lastname: Rivara
authors.forename: S
authors.initials: S
authors.lastname: Tollefson
authors.forename: E
authors.initials: E
authors.lastname: Tesh
authors.forename: L M
authors.initials: LM
authors.lastname: Gentilello
mesh_terms: D000437:Alcoholism / Q000150:complications* / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D003219:Confidentiality / Q000331:legislation & jurisprudence; D003376:Counseling / Q000191:economics / Q000331:legislation & jurisprudence / Q000379:methods; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D019458:Insurance Coverage / Q000191:economics* / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000331:legislation & jurisprudence; D016365:Liability, Legal; D008403:Mass Screening / Q000191:economics* / Q000331:legislation & jurisprudence / Q000379:methods*; D009104:Multiple Trauma / Q000150:complications*; D010344:Patient Advocacy / Q000331:legislation & jurisprudence; D010820:Physicians / Q000523:psychology; D014481:United States