Insurance and billing concerns among patients seeking free and confidential sexually transmitted disease care: New York City sexually transmitted disease clinics 2012.

Background: Historically, New York City (NYC) Department of Health and Mental Hygiene (DOHMH) sexually transmitted disease (STD) clinics have operated completely free of charge but will soon begin billing patients for services. To inform billing strategies, we surveyed NYC DOHMH STD clinic patients in fall 2012 to examine response to the prospect of billing insurance and charging sliding-scale fees for services.

Methods: A total of 5017 individuals were surveyed from all patients accessing clinic services between September and December 2012 at 8 NYC DOHMH STD clinics. The anonymous survey was provided at registration to all patients, in English or Spanish. The data were analyzed to determine patient insurance status and other characteristics related to billing for STD services.

Results: More than half of respondents (51.0%) were uninsured, and 42.3% were unemployed. For 20.2% of respondents, billing would pose a considerable barrier to care. Nearly half of those insured (48.4%) said that they would not be willing to share insurance information with the STD clinics.

Conclusions: Respondents who said they would not access STD clinic services if charged represent approximately 13,600 individuals each year who, if not promptly diagnosed and treated elsewhere, could be a continuing source of STIs including HIV. Confidentiality concerns and income are potential obstacles to billing insurance or charging a direct fee for STD services. New York City DOHMH plans to take the concerns raised in the survey findings into account when designing our billing system and carefully evaluate its impact to ensure that the need for accessible, confidential STD services continues to be met.