Who Can Access an Explanation of Benefits?
An Explanation of Benefits (EOB) outlines in detail the benefits a contract holder or policyholder is eligible for under their health insurance plan. The contract holder/policyholder may receive EOBs for all persons covered under the plan.
Right of Access to Information Under the Privacy Regulation
The right to inspect or receive copies of protected health information (PHI) is limited to the individual who is the subject of the information or a legal personal representative including:
The following are not considered legal personal representatives with regard to the above noted right to access:
Regardless of the relationship to the individual, the release of information concerning birth control, alcohol or chemical dependency and mental nervous treatment is subject to specific restrictions and requirements under state and federal law.
Persons involved in the care or payment for care for a member are referred to as advocates acting on behalf of a member. A person in this capacity must provide the following information in order to confirm their identity and authority:
For example, in order to provide claim status or claim payment information, the caller must be able to verify the name of the provider, date of service, amount of charge and type of service. Regardless of who is calling, we do not release diagnosis or specific procedure information over the phone.
Privacy of Members' Medical Information
Wellmark is required by applicable federal and state laws to maintain the privacy of our members' medical information. Wellmark is required to give our members notice about our privacy practices, our responsibilities and members' rights concerning their medical information. The business affairs and records of our company are confidential. They are not to be shared with anyone inside or outside the company, except for those who need to know in order to conduct the business of our company.
The steps Wellmark has taken to safeguard members' medical information include but are not limited to:
Maintained strict security regarding access to facility, personal computers and medical information