Clarification on new law requiring member communications about sensitive conditions

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Clarification on new law requiring member communications about sensitive conditions

November 18, 2019


We wanted to share an important update about the change to member-level communications happening in 2020.

As we recently let you know, starting in January, communications about sensitive health care will go to the member rather than the subscriber under a new Washington law. Part of that change includes explanations of benefits (EOBs), which will now go to members directly, both in print and online.

This change to EOBs also applies to self-funded groups, even if they have opted out of complying with the new law. Subscribers will still be able to see claims information for members online, but EOBs will be sent by mail or online directly to members only.

All members are encouraged to register for an online account at regence.com to see their EOBs and other helpful information. We will notify members of this change via mail in the coming weeks.

We have provided an updated FAQ below with this and other information about the change for your reference.

Other legislative update: Balance Billing Protection Act
Beginning Jan. 1, 2020, state law protects health plan members from ‘balance (surprise) billing' if they receive emergency care or are treated at an in-network hospital or outpatient surgical facility. No patient in an emergency has the ability to check a provider's network status, and we believe no one should face high medical costs they didn't expect from their provider. Under the Balance Billing Protection Act, the most members can be billed for emergency services – including surgery, anesthesia, pathology, radiology, laboratory and hospitalist services – is their plan's in-network cost-sharing amount, even if those services are received at out-of-network hospitals and providers. The law also provides protections for members should they be balance billed in error.

Self-funded groups have the option to elect participation in certain provisions of the law. It does not apply to self-funded groups unless they specifically opt-in, which they can do starting Jan. 1, 2020, or at their renewal date.

FAQ: Change to member communications

What is this change about?
Our goal is to give our members personalized communications whenever possible. Starting in January, we will send communications about sensitive health care services to members age 13 and older of Washington-state based health plans rather than to the subscriber. This is part of a new Washington state law that takes effect Jan. 1, 2020.

What does that mean?
This means that these communications will go to the person who received the care if they are age 13 and older, rather than to the subscriber, the person who signed up for health insurance. Previously, explanations of benefits (EOBs) and claims for all members were mailed to the subscriber or displayed on the subscriber's online account. After Jan. 1, 2020, all EOBs will be mailed to the member or available only on the member's online account. EOBs and claims for members younger than 13 will continue to display on the subscriber's online account.

Why is that important?
We recognize the importance of member privacy, and we are committed to keeping health information private for any members, including minors, who might be vulnerable if it is shared.

What kind of information is included?
All EOBs, whether printed or online; claims communications; provider name and address; description of services provided; any written, oral or electronic communication that references protected health information; requests for additional information from us about a claim.

What types of communications does this law cover?
Print, digital (online), voice, email and chat communications, including calls to Customer Service. Those who have opted in to digital communications online, such as EOBs, will see only member-level information.

What if I have turned on family sharing online?
Family sharing will enable the subscriber to see claims for the member except those for sensitive health care services. EOBs will be accessible only on the member's online account or in print. Each member age 13 and older should register for an online account to see EOBs online.

How do members get access to their personalized information?
Members ages 13 and older will get information, including EOBs, mailed directly to them at the address we have on file or they can register at regence.com and view information through their online portal. Members younger than 13 can contact Customer Service to direct information to someone other than the subscriber, as we are more constrained in how we may communicate with them.

Does this mean a parent cannot have information about a dependent child automatically sent to them?
Yes, communications about sensitive health care services will go only to the member. If a subscriber wants access to information regarding an adult dependent or a child 13 or older, the dependent or child may decide whether to grant authorization for that access. Authorization applies only to voice communications or requested copies of documents. It would not extend to online accounts or online access to EOBs or claims for sensitive health care. Digital and printed communications will still automatically go only to the member.

How do I get more information about this change?
Additional FAQs and other information, such as relevant privacy and disclosure forms can be found regence.com/go/memberprivacy2020.

Are all health insurance companies doing this?
All Washington state-licensed health insurance companies are required by law to direct communications about sensitive conditions to the member under Senate Bill 5889.