Does employer get copy of EOB?

Question

Maybe it's changed since HIPAA but I used to assist in an HR dept of a large company and I swear I remember filing copies of all employees EOB's. Is this possible today with privacy laws. How about if a company is Self-Insured would that be reason for them to receive them?

Answer 1

Employers can get copies of EOB's, but it will not contain any Personal Health Information (PHI) of the EE.  PHI information includes and diagnosis, treatment, EE personal information, etc.

EOB's are sometimes applicable for medical, dental or disability insurance where the insurer needs to communicate how much the Employer needs to pay if they are self-funded (ER pays benefits and Insurance company is administrator).

There are other ways of communicating this information through other types of reports, but it varies depending on the insurance company.

Although many larger companies will use TPA's, most of your smaller ones (under 1,000 lives) do not.

Answer 2

Employers don't get copies of EOBs.  

Most self insured employers use a TPA, to avoid any privacy law issues.  The EOB gets issued by the party paying the bill.  So, there IS no EOB issued, if the employer has a department to pay the bill.  Or rather, the employer writes it up.

Still, that information is closely guarded, so that "just anyone" can't see it.  AND, it can't be used to make firing decisions.