The Explanation of Benefits Statement
To have a better understanding of EOBs, it is important to note that at first glance, an Explanation of Benefits statement closely resembles a medical bill. The EOB usually says at the top “This is Not a Bill”; however, it may look like the recipient owes money.
EOB forms give details about a specific medical insurance claim that was processed by the insurer. It explains how much of the insurance claim was paid by the insurance company and how much is outstanding, based upon the costs of the care provided and the individual’s health insurance plan.
To illustrate with an example, consider an allergy screening. The allergist charges a set fee for service, and a health insurer pays a certain amount of that, which is dictated by the individual policy, deductible amounts, and other variables. Individuals usually pay a co-pay at the time of appointment but may owe more money later once the insurer processes the claim if there’s a difference in the service cost and what the insurer will cover.
In addition to details about the specific procedure, the Explanation of Benefits forms usually contains policy-specific information, which adds context. After summarizing the recent claim, the EOB form will usually summarize the deductibles and any other out-of-pocket claims for the year.
This way, the insured can better understand what they owe by reviewing how much of their deductible they’ve already paid. While EOBs explain medical billing information to the insured, they can be challenging to understand, and errors can happen. Many patients need to call their insurer to ask targeted questions, so they can better understand both the EOB form and any subsequent medical bills that arrive.
EOBs generally come after any medical or dental service is provided. Dental EOBs are similar to medical EOBs in form and function and have the same requirements. However, since dental insurance is limited in its coverage, patients who need extensive dental procedures may owe far more than they would for medical care.
EOB Mailing Requirements
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. HIPAA mandates that an individual’s health conditions, demographic information, services received, and payment for services be kept confidential.
Thus, any medical information, including adolescent children, that mentions the past, present, or future health care information (including fees for services rendered) must respect the privacy rule regardless of how the data is transmitted (via direct mail or electronically).
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 HIPPA 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.
Digital 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 confidential statement generation or electronic communication services. Since digital communication companies specialize in printing and sending campaigns, hard copies, or electronically, they can do it efficiently.
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. Digital 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 to patient online portals or emailed, streamlining the EOB mail process for insurers.
Since forms must be addressed to individual patients, 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.
To ensure security and confidentiality protection, insist upon a direct mail provider that has a HITRUST and HIPPA certification, 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.
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 their members while saving the customer money.
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 or only need help with EOB mailing, we can take care of everything quickly and accurately.
When you are dealing with Explanation of Benefits you must be certain that all HIPPA 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.
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