Explanation of Benefits

[karen1027]

The health insurance company has released copies of EOB's to the employer. Is this a violation of HIPAA laws?

[Chaz]

It depends on the reason why the insurer did so and/or whether the patient sign a valid authorization for the disclosure.

[karen1027]

The patients did NOT sign any authorization. I advised the plan administrator that there were several claims that I had not received reimbursement. There is a QMCSO in effect, but is not followed. Plan adminstrator requested dates of service, patient's and provider's name.

In response, I received copies of a couple of "Claim Details" and several EOB's, most of which were not for the dates of service I indicated. Also the EOB's do not indicate to whom paymnet was made..

[karen1027]

Shouldn't EOB's indicate who received payment from the insurance company?