can your employer ask for your insurance statements that comes in the mail showing what they paid your Doc.?

Question

I would like to know if your employer can ask for your insurance statements that come in the mail showing what they paid your doctor visit and tests done and your balance (co-pay) what is left and extra. Its when you go to the doctor your doctor bills insurance company and insurance company send you the information regarding what they paid and what you owe. Looking for web sites on his. (does hipaa have anything on this?) Thanks

Answer 1

The privacy rules added to HIPAA do, in fact, apply to this situation. Under the HIPAA privacy rules, employers can request and receive LIMITED information from carriers in order to confirm utilization rates, etc. However, the information an employer receives is not "personally identifiable," in other words, the employer won't receive a list of each service, drug, etc, that a named employee or dependent received. It's supposed to be completely anonymous.

Your employer can request this information from you, but they cannot require it; nor can your employer obtain it from the insurer, since it would be "personally identifiable." If you object to providing the information, (which most folks would), you are under no legal obligation to comply.

Answer 2

Why in the WORLD would your employer want this information? I believe it violates the privacy laws. And I can't think of ANY reason, except nosiness, why the employer would want that information.

The co pay and balance due, not to mention tests, and the amount paid out, are NOT your employer's business, and don't affect them AT ALL. No one can go after the employer, if you don't pay your copay.

If they insist, ask to see where in the employee handbook it says you have to show it, or ask them to put the request in writing. Then go ask a laywer (one of those free consult things) if the employer is allowed to do that. I'm pretty sure they'll say no. That just covers you, if the employer should like, try to fire you over it or something.

Answer 3

it sounds like the reason why they are asking is b/c your employer is self-funded which means they foot the bill for all of it's employees and their family members under the insurance plan. they are entitled to see some information which they can access themselves by calling customer service or if they have access through HR to view claim on the Web. they are probably trying to audit the claims to see why they pay so much in health claims and trying to find ways to keep costs down. remember, it's the employees of a group that keep the premiums rising every year - b/c of over utilized and unnecessary services.

Answer 4

That is none of their business. Just so you know the form you are talking about is called the explanation of benefits (EOB)

Answer 5

NO