Identity thieves steal personal information – say, your Social Security number – to use for many purposes. Some want to open a credit card or take out a loan in your name.
Others use your Social Security number or other information, such as a health insurance account number or a Medicare account number, to have you billed for doctor’s visits, prescriptions, medical devices, or even a surgery. This is called medical identity theft.
Medical identity thieves can hold you financially responsible for expensive medical procedures and equipment as well as prematurely exhaust your benefits while a scammer uses your insurance or Medicare plan for medical treatments. This criminal behavior can also lead to misinformation becoming part of your medical file, which can lead to improper treatment and other dangerous errors affecting your future care.
To ward off medical identity theft, keep all of your medical insurance records in a safe place. Such records include health insurance enrollment forms, cards and explanation of benefits statements; Medicare summary notices; billing statements from medical providers; and prescriptions and prescription bottles.
Remember that identity thieves will dumpster-dive and go through an unlocked mailbox to try to uncover personal information. As with other sensitive information, statements containing medical details should be removed from your mailbox as soon as possible. Consider receiving medical bills and statements online to help limit the amount of information you get by mail. Shred medical information you no longer need, and use a permanent marker to block out information that cannot be shredded.
Here are some red flags from the Federal Trade Commission (FTC) to help spot medical identity theft:
- You receive a doctor’s bill or an explanation of benefits for services you didn’t receive or prescription medication you don’t take. Be sure to read your insurance company’s explanation of benefits and Medicare’s summary notices to verify every charge.
- A debt collector contacts you about a medical debt you don’t owe.
- Your credit report shows medical debt collection notices that you don’t recognize.
- You receive a notice from a health insurance company that you’ve reached your benefits limit.
Consumers looking for a self-help plan to recover from identity theft can visit
www.IdentityTheft.gov.
Surprise billing
Recent federal and state laws protect consumers with private health insurance from receiving and paying medical bills at amounts higher than the in-network insurance amount for emergency or other unanticipated out-of-network care. Potential scenarios include receiving emergency care at an out-of-network facility and receiving some services, such as imaging, from an out-of-network provider during scheduled care with an in-network provider. In circumstances such as this, providers are generally not allowed to “balance bill” the patient and must work out any payment differences with the insurance company. Patients may still receive a bill because, under the laws, they remain responsible for any amounts (as copays and deductibles, for example) that meet the in-network limits.
Based on these laws, patients with health insurance should not receive surprise bills for unanticipated out-of-network care for services performed in or after 2022.
Consumers receiving a surprise bill that they believe violates these laws can first try to resolve the issue directly with their insurance and care provider. Unresolved disputes can be reported to the Ohio Department of Insurance at
consumer.complaint@insurance.ohio.gov or by calling 800-686-1526. For more information about surprise billing, click
here to access the Department of Insurance’s surprise billing toolkit.