EOB as a “Health Record”
Is an insurance company’s or health plan’s Explanation of Benefits (EOB) part of a patient’s health record under HIPAA or State law?
How long must I keep an Explanation of Benefits forms?
An EOB form is part of a patient’s health record because it contains individually identifiable information related to the patient’s physical or mental condition. Therefore, both federal HIPAA rules and State law apply. HIPAA requires that covered entities maintain patient records for at least 6 years. The Illinois Medical Practice Act requires that physicians maintain patient records, but does not specify a period of retention. Based on malpractice laws, the ICS recommends a minimum of 10 years from the date of the last encounter for adult patients. For children, the recommendation is 10 years from the date of the last encounter, or when the child reaches 20 years of age, whichever is longer. This standard accommodates the medical malpractice statutes of limitation and exceeds the requirement in the HIPAA Rules.
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In addition, EOBs reflect payments that affect income. All physicians should check with their tax professionals as to whether they recommend keeping EOBs for a longer period than under the guidelines above.
