Have you ever heard of “Patient identity theft?”
So, don’t be surprised if the next time you visit your dentist, chiropractor or other health care provider that you are asked to provide proof of your identity with a piece of photo ID. If you are a new patient that is not yet familiar to the staff, a photo ID may have to accompany your dental insurance card.
Insurance companies are reporting a rise in identity theft to falsely obtain health care services. In dentistry, patient identity theft occurs when someone uses another individual’s personal information to obtain access to dental services and insurance benefits. This translates into money having to be paid back to your insurer and inaccurate treatment information being entered into the personal data they have on file for you. You may even lose your benefits.
A person with a dental emergency may be fortunate enough to schedule a dental appointment for same day treatment of a specific dental emergency – for let’s say, a broken filling or tooth. Equipped with the name, address, birthdate, and employer of an individual other than themselves, they provide the administrating staff with this personal information as well as the insurance policy numbers needed to file a claim for said treatment. They may also present the actual dental insurance ID card and the office may agree to this method of payment.
Treatment is performed, the online claim is filed and acknowledged and the person leaves – never to be seen again. No one is the wiser unless the insurance company rejects payment or the legitimate patient discovers the fraud while reviewing their benefit statement.
Sometimes, however, the fraud is only discovered when a person has similar treatment performed on the same tooth. Let’s say, or example, a person using someone’s identity has a tooth removed. If the actual person has dental care, such as a filling, performed on that same tooth their insurance will refuse to pay out benefit money for a tooth that their records indicate has already been removed. Other times, a person discovers the fraud when they realize that all of their benefits have been used up or “maxed” for the year even though they have not received the equivalent amount of treatment.
This is where it becomes complicated, time-consuming and frustrating for the victimized patient and the dental office. When the insurer discloses the information they have on file, the office and/or patient must provide proof that this treatment was never performed on the legitimate individual. It becomes an administrative nightmare when the investigation begins. Ultimately, the first dental office that provided this service to the fraudulent person will have to pay back all of the monies paid out to them by the insurance company.
How To Protect Yourself
Anyone who has access to your insurance information can try to submit a fraudulent claim. Here are some practical steps you can take to help protect yourself and your benefit plan:
1. Request that your insurer send you a statement of all dental transactions even if payment was paid directly to the dental office. Review the information carefully to ensure it’s accuracy. An online source of this information would be more preferable rather than a postal mailing. Report any suspicious activity immediately to your insurer.
2. Safeguard all documents that contain your personal information. If you like to keep a copy of dental statements, do so in a safe and secure place or convert them into an electronic format.
3. If contacted by email or telephone, never confirm any personal information even if the person making the inquiry seems legitimate. Instead, call your insurer using the telephone number on your ID card or a recent statement and ask if they are requesting this information.
4. Do not carry your dental ID card in your wallet. Keep it in a safe and secure location.
5. Never sign a blank insurance form and review any claims submitted on your behalf. Request a copy for your records.
6. Ask your healthcare provider how they handle and disclose your personal information. All dental offices in the province of Ontario have to keep this information on hand and available to patients.
7. Never “lend” someone your insurance benefits. Even when you think you are being helpful by providing a friend or family member with access to your personal dental benefits you are only harming yourself and any future care you may need. Your insurer will take action against you. Not only will you lose your benefits, you can be charged with fraud and prosecuted.
8. Make sure to regularly update the antivirus and antispyware on your computer.
Never be offended if you are asked to provide proof of your identity
Unfortunately, identity theft is a growing trend and we must all be vigilant. Never be offended if you are asked to provide proof of your identity. You are entrusting your healthcare providers with your personal information and until more insurance companies begin providing photo dental ID cards to their clients, it is a considerate and reasonable safeguard done for your protection.
Everyone involved becomes a victim. This is one of the reason why many insurance companies are dealing with the owner of the policy only and why healthcare providers are now expecting their patients to pay the entire charge at the time of service. It is also one of the contributing causes for the ever rising costs of healthcare and benefit premiums. All of this makes access to healthcare more difficult.
So remember, you can decrease your dental and financial risk in an identity theft situation. Be Smart! Be Safe!
The Your Smile Dental Care Team