By Jim Haigh, Keep Me Posted
The recent passage of the “No Surprises Act” is being hailed as a major victory for patients and consumers. Effective January 1, 2022, the new federal law will prevent patients from receiving surprise medical bills resulting from gaps in coverage for emergency services and certain services provided by out-of-network doctors and other providers at in-network facilities.
Unfortunately, critical documentation that medical consumers rely on to catch and dispute these surprises might not be where they’ve always found it: in their mailbox.
Explanation of Benefits (EOBs) are essential notices that help patients understand how much each service costs, how much their insurance plan will cover, and how much they will have to pay their doctor or hospital. Until very recently, it had been a universal health insurance industry best practice to mail paper EOBs to plan members by default.
Over the course of the pandemic, Keep Me Posted (KMP) has received multiple complaints of major insurance companies automatically switching their customers from paper EOBs to digital communications without receiving clear permissions or express consent.
The potential harms from forcing consumers into electronic delivery of EOBs — rather than asking beneficiaries to voluntarily opt in to new communications preferences – are serious and numerous. Without traditional access to itemized claim details of healthcare services displayed in an easy-to-read, printed format, surprise medical bills will be much harder to spot. This is true for both simple accounting errors and potential fraud, all of which could go unnoticed and unchallenged.
When insurers send information to beneficiaries electronically without consent and without confirming current email addresses, confidential HIPAA-covered information could potentially be at risk. And beyond the consumer rights and liabilities, the basic and essential knowledge of how much has been paid towards plan deductibles, out-of-pocket limits, the amount saved and still owed could be jeopardized, along with information necessary for tax purposes.
In addition, many consumers who have difficulty accessing online technologies, have concerns about online security or require paper communications for practical reasons are disadvantaged by EOBs that are delivered electronically by default. Among those most at risk are older adults, people with disabilities, those in low-income households who cannot afford computers or broadband service, and people in rural areas where unreliable internet access is common. Because EOBs have statutory, regulatory, tax, fraud prevention and consumer rights implications – including new protections against surprise medical bills – electronic delivery by default poses real and unnecessary harm to our most vulnerable populations.
To protect all consumers, Keep Me Posted urges health insurance providers and regulators to assure default access to EOBs free of charge, using the most easily accessible and universally available option: paper delivered through the mail. The costs to consumers for not doing so are far greater than the cost of a postage stamp.