Are EOBs mandatory?

[gauss]

I have group PPO medical insurance through my wife's employer. I am accustomed to receiving an Explanation of Benefits (EOB) statement for each medical transaction (excluding pharmacy).

Recently there was a billing issue where the insurance company did not provide an EOB and a provider was having trouble getting paid. Ins. Co. insisted that provider was payed in a "bulk payment" and thus no EOB was to be provided. The provider backed down after conferencing w/Ins. Co., but I am not sure if provider wrote off the amount, or if they were able to indeed locate the payment.

My question today is: Does anyone know if EOBs are optional, or are they regulated in some fashion? Under what conditions can EOBs be expected?Thanks
-gauss

 

[Gotadimple]

Providers don't get EOBs, you do. Yes, you are required to get one. Did you not get one?

Usually, Insurance Companies provide a voucher statement that shows the claims being paid.

 

[gauss]

Providers don't get EOBs, you do. Yes, you are required to get one. Did you not get one?

That is correct. I did not get an EOB. First time I have had this problem. Ins. Co. said that EOB cannot be sent to me because the payment to the provider was part of a "bulk payment" - ie multiple claims from multiple people paid with 1 payment to provider.

I am trying to figure out if the Insurance Companies are allowed to do this (not send EOBs for a PPO plan) and if so under what conditions.

-gauss

 

[John Galt III]

A couple years ago my employer based group health insurance stopped sending me eobs for routine annual physicals, that were free to me. Still got eobs for everything else though.

 

[Gotadimple]

That is correct. I did not get an EOB. First time I have had this problem. Ins. Co. said that EOB cannot be sent to me because the payment to the provider was part of a "bulk payment" - ie multiple claims from multiple people paid with 1 payment to provider.

I am trying to figure out if the Insurance Companies are allowed to do this (not send EOBs for a PPO plan) and if so under what conditions.

-gauss

The best way to find out this info is to contact your state insurance commissioner.

-- Rita

 

[MRG]

When I went on COBRA I stopped getting EOBs. When they switched me the default was no paper only electronic. I had used my Megacorp's email, I swiched this to my personal email before retirement. Somehow that change in email address got lost.

I think they're required, but that could be at the state level. Your states insurance commission will know for sure. I've found that just mentioning that office( I always include the name of the commissioner), sometimes makes a difference.

MRG

MRG