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Mailing of EOB's and other docs under HIPAA


Guest ro32

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Does the Privacy Rule (or some other law) permit a health plan to send correspondence (e.g. EOBs) directly to the primary insured, even if such correspondence concerns a dependent? It is my understanding that many plans are continuing to send EOBs to the primary insured even if the document concerns a dependent. I gather that if a dependent wanted to receive communications from the health plan directly to them, they could request the plan to do so (request for confidential communications). Since I could not find a specific HIPAA regulation approving or disapproving of the action, I figured I would pose the question to the experts!

Thanks.

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The Privacy Rule does not specifically state that EOBs cannot be mailed to the primary insured. So I believe that this falls under the category of "Payment." Please see the follwoing FAQ from HHS' website:

Question:

Does the HIPAA Privacy Rule permit a covered entity or its collection agency to communicate with parties other than the patient (e.g., spouses or guardians) regarding payment of a bill?

Answer

Yes. The Privacy Rule permits a covered entity, or a business associate acting on behalf of a covered entity (e.g., a collection agency), to disclose protected health information as necessary to obtain payment for health care, and does not limit to whom such a disclosure may be made. Therefore, a covered entity, or its business associate, may contact persons other than the individual as necessary to obtain payment for health care services. See 45 CFR 164.506© and the definition of “payment” at 45 CFR 164.501. However, the Privacy Rule requires a covered entity, or its business associate, to reasonably limit the amount of information disclosed for such purposes to the minimum necessary, as well as to abide by any reasonable requests for confidential communications and any agreed-to restrictions on the use or disclosure of protected health information. See 45 CFR 164.502(b), 164.514(d), and 164.522.

I think as long as you follow minimum necessary and allow for restrictions and confidential communcication, you are fine.

.

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