When the oral surgeon recommended that our daughter have her wisdom teeth removed, we thought we knew what to expect both medically and financially. Morgan's two sisters underwent this procedure in the past, and we adopted a brave “Let's get this over with!” attitude as we scheduled her operation.
We expected the least painful part of the procedure to be the surgery bill because the girls are covered under both their parent's dental insurance. It was an unpleasant surprise to learn from the oral surgeon's billing manager, “After checking with your insurance, we estimate that your daughter's surgery will cost you about $1,200 out-of-pocket since she has exhausted nearly all of her benefits this year.”
Something was wrong!
It was late in the day when we discovered that our insurers were planning to deny benefits, and we wracked our brains that evening trying to imagine why, with double insurance, Morgan lacked coverage. Had we forgotten about treatments she received? Were we mistaken about dates when she received services? Could the insurance company records be incorrect? Or, might this be something more sinister, such as medical identity theft?
Medical identity theft
The Federal Trade Commission (FTC) explains that “A thief may use your name or health insurance numbers to see a doctor, get prescription drugs, file claims with your insurance provider, or get other care. If the thief's health information is mixed with yours, your treatment, insurance and payment records, and credit report may be affected.”
Medical identity theft's most damaging outcome occurs when a victim receives an incorrect therapy or medication due to the co-mingling of the victim's health history with that of the thief's. The financial consequences can be painful as well, including:
- Higher insurance premiums due to your apparent high benefit usage.
- Calls from debt collectors demanding payment for services you never received.
- Damage to your credit report that results in your inability to secure a loan or causes an employer to think twice about hiring you.
- Benefits denied until you pay your deductible.
Relief — a simple error brought to light
In our case, multiple phone calls to our daughter's dentist and both insurance companies finally shed light on why benefits appeared to be exhausted: Morgan's twin sister, Margaux, had received several dental treatments during the past year. When the oral surgeon's office called to verify coverage, two girls with the same date of birth and same first initial and last name were confused by the insurance representative who erroneously reported that Morgan's benefits were tapped out when she actually had more than enough available to cover the surgery.
The misunderstanding was corrected after less than an hour's work on the phone, but had this been a case of medical identity theft, we might have had to pay $1,200 for her procedure and may have struggled for months to clear up false patient records.
Having experienced the worry associated with a potential medical identity theft, and the relief when we discovered our daughter's health records were safe for now, we became vigilant about doing what we could to prevent and detect this type of crime.
[Read how you can prevent medical identity theft and protect your finances and health history: The identity theft no one is talking about.]