Do You Know Your Explanation of Benefits Mailing Requirements?

Health insurance providers are required to send Explanation of Benefits (EOB) statements after a patient receives health care services. These forms detail how a claim was processed, including what portion was covered by the insurer and what amount, if any, remains the patient’s responsibility—based on the individual’s healthcare plan and the cost of care. Because EOBs contain sensitive medical and financial information, they are protected under HIPAA regulations. As a result, insurers must follow strict guidelines regarding how EOBs are generated, delivered, and stored—balancing compliance with patient privacy and communication preferences.

EOB Mailing Requirements

HIPAA Compliance & Mailing EOB’s

While some patients choose to view their Explanation of Benefits online, many patients are reluctant to view sensitive information online and would prefer to receive a hard copy by mail.

Our  Statement Generation  or  print on demand services make it simple to create and mail personalized EOB statements to users as the need arises. HIPAA’s privacy rule affects statement generation and EOB mailing requirements.

Key EOB Mailing Requirements

• Protected Health Information (PHI) must be secured during all stages of handling—printing, storage, transport, and delivery. PHI includes any data that identifies a patient and relates to their health conditions, treatments, demographic information, or payment.
• Mailings must comply with HIPAA Privacy and Security Rules. HIPAA does not mandate how EOBs are delivered (paper vs. digital), but it does require that delivery methods safeguard patient privacy.
• Patients must be given the option to receive paper EOBs, unless they have explicitly opted for electronic delivery. This is reinforced by recent rules under the 21st Century Cures Act.
• Mailings must be addressed to the correct individual or authorized party. Variable data printing should be used to ensure personalization and prevent mismailing.
• Adolescent privacy protections apply. In some cases, insurers may be required to send EOBs confidentially for minors or dependents (especially regarding sensitive services), depending on state law.
• Mail vendors must sign a Business Associate Agreement (BAA) with the health plan or provider if they handle PHI. This is a legal requirement under HIPAA.

Given that your medical organization must comply with HIPAA, any direct mail or electronic service you work with must have a thorough understanding of HIPAA and its privacy laws, and be able to send out confidential medical information in an appropriate manner. Knowing your EOBs is important. Preferred Direct complies with all HIPAA requirements.

An insurer cannot be held liable if a patient’s confidential information is disclosed when all proper measures are taken. However, if an insurer does not take proper steps to preserve the integrity of private information, and they are found to be negligent, they will face fines that range from $100 to $50,000 for every violation.

Protected vs Non-Protected Healthcare Mailings

Direct communication companies, like Preferred Direct, provide insurers with a range of medical statements, including EOBs, medical bills, plan benefits, and other healthcare forms, electronically or hard copies. While healthcare marketing materials may not have any private patient information, thus be exempt from HIPAA.  An individual’s sensitive medical forms must have their confidentiality protected.

Sending EOB Statements

Preferred Direct is a knowledgeable partner for insurers who want to outsource their billing to a third party who can provide fast, accurate, and HIPPA-Compliant statement generation or electronic communication services. Since direct communication companies specialize in printing and sending campaigns, hard copies, or electronically, they can do it efficiently.

Outsourcing EOB Mailings

Outsourcing this service also saves time while allowing employees to focus on mission-critical tasks. Patients enjoy receiving accurate materials promptly.  Preferred Direct’s communication services generally accept health data in a variety of formats, including .csv, .xls, or .txt. Direct communication companies using the supplied data will generate an accurate Explanation of Benefits statement.

Preferred Direct also offers e-billing services, in which medical bills and EOB statements can be generated and electronically transmitted through patient online portals or emailed, streamlining the EOB mail process for insurers.

Key Outsourcing Considerations

Confidential Personalization. Since forms must be addressed to individual patients as part of HIPAA compliance, look for a direct mail shop that offers variable data printing, in which patients’ names and other unique data can be included in the mailings for customized, meaningful communication.

Compliance & Certifications. To ensure security and confidentiality protection, insist upon a direct mail provider that has a HITRUST certification and maintains HIPAA compliance, which is the most common security framework for healthcare data in the U.S.

Preferred Direct has HITRUST certification and keeps up to date with all HIPAA requirements so that we can serve our insurance industry customers.

Industry Mailing Experience. Not only are we attentive to the healthcare industry requirements, but we also offer highly efficient direct mail services. Since we use match mailing and postage automation services, we can efficiently process and send an Explanation of Benefits statement to thousands of members while saving money.

Inventory & Product Diversification We create and maintain customized printing products for our customers, and we update our in-house stock with measures for inventory control. This way, we’re always ready for your next mailing. Whether you’re looking to outsource all of your medical statements, marketing collateral, member handbooks and more, look for a printer that is an all-in-one source to streamline communications and order management.

Conclusion

When you are dealing with Explanation of Benefits you must be certain that all HIPAA rules are met.  Be especially careful with any and all information relative to the person, and that information should be treated with the utmost confidentiality.

There are savings to be had by outsourcing the EOB statements to a competent print and mail production house. Consider Preferred Direct, the preferred print and mailing partner for health and insurance enterprises nationwide. Request a project estimate or receive some samples to get started.