Massachusetts Governor Charlie Baker signed into law a new patient privacy requirement for health insurers.

For families who have everyone on one health insurance plan, the Explanation of Benefits (EOBs) are sent to the subscriber.  This includes dependents who are adults, but who remain on their parents’ insurance through college, or spouses.  Now, health Insurers will be required to send patient EOBs directly to the patient rather than the subscriber.

One of the reasons this law went into effect is because lawmakers understand that patient confidentiality is important in the patient-provider relationship.  Many patients can be hesitant to speak truthfully about certain aspects of their symptoms and care if they know other people might know about it.  Some examples might be mental health, sexual issues or sexually transmitted diseases, or signs of abuse.

Lawmakers saw that there were potentially harmful repercussions to patients with EOBs sent to the subscriber. One such example was if a spouse is abusive and the other spouse leaves and receives treatment at a local facility, the abused spouse may be in a life-threatening situation because the EOB would alert the abuser to the location of the victim.

What does this law provide?

Health Insurers will send ‘member-level’ EOBs to the patient, rather than to the primary subscriber and will allow patients to choose their preferred method of receiving EOBs, including at an alternate address or through HIPAA-compliant electronic means. Additionally, patients would have the option to opt-out of receiving an EOB when no remaining balance exists on a claim. This means that EOBs could be fully suppressed for preventive health services with no cost sharing (e.g. a birth control refill visit, STI test or domestic violence counseling). EOBs will now need to provide generic information only, such as “office visit” or “medical care,” rather than more explicit descriptions that could violate confidentiality.

Finally, the Division of Insurance and Department of Public Health will educate providers and patients on these protections.


To learn more about patients’ rights and how you can best protect them, join HIPAAgps today.