A 21-year-old attends with his mother, who is paying for the entire course of treatment. How should you handle her questions about his care?

Correct answer: C. Discuss the treatment with her only with the patient's permission

• A. Financial responsibility and health information rights are entirely separate. A payer is entitled to know what they are being billed for, not to a clinical discussion.
• B. An adult with capacity signs his own consent. A parent cannot consent on behalf of a competent adult child.
• C. CORRECT. He is a legal adult. Paying the bill confers no right of access to protected health information. You need his authorization — which in practice is a simple question asked in front of both of them: 'Is it alright with you if I discuss this with your mother?' Document the answer.
• D. Refusing outright is unnecessary and needlessly damages the relationship. Permission is easy to obtain.

Note: The clean way to handle it: ask the patient at the start of the visit whether he wants his mother present for the discussion, note his answer in the record, and proceed accordingly. HIPAA permits disclosure to a person involved in care if the patient has agreed or has not objected when given the opportunity.