Keep tabs on your health insurance claims

by Karen on January 14, 2009

We’re all aware of the dangers of identity theft these days. Most people keep a close watch on their bank accounts, credit card statements, and credit reports to ensure they’re not being victimized. This week I had a scare that made me realize my credit report isn’t the only way my identity could be stolen.

A few months ago, I received a letter from my health insurance provider warning me that a recent claim had been denied. Aside from the fact that I hadn’t recently filed a claim, I was alarmed because I had never even been to the hospital where the claim was filed. It was also filed on a date before my insurance was even active.

I called my health insurance company, and they apologized and assured me that it was a mistake that I didn’t have to worry about. I tore up the letter and forgot about it.

Last week, I received another letter with the same message. Only this time, it was for a separate service at the same hospital two months later.

I called my insurance again. This time, they looked up my information and said, “Yes, I see a claim filed at _______ Hospital on August 15.”

It told them I’d never been to _____ Hospital. In fact, it’s not even located in the state where I live.

The woman on the phone verified my name and address, and said that yes, this claim had been filed in my name with my information. She also verified the second claim from two months before, the one that I had been assured was a mistake that I didn’t need to worry about.

“You’ll have to call the hospital and find out why they’re filing claims in your name.”

Um, no. “You’re telling me that it’s my responsibility to look into fraudulent claims? I don’t think so.”

When I said this to the customer service rep, she acted irritated and transferred me to the claim dispute resolution department.

Um, thnx. You probably should have done that in the first place, lady.

After verifying my information, I was put on hold while the dispute resolution rep called the hospital to find out why this was happening.

After 5 minutes on hold, I was relieved to find out that it was a clerical error after all. No one had filed the claim in my name with my information. Someone with the same last name and health insurance provider as me filed a claim, and it was accidentally put into the wrong file in the computer system. They corrected the error and assured me that I wouldn’t receive any more notices.

I’m confused how this could happen not once, but twice. But I’m relieved that it wasn’t an issue of identity theft.

From now on I’ll include my insurance claims information on my watch list. Because I rarely need medical care, I don’t check my insurance information very often. This error was in my file long enough that I started receiving nasty letters about it. It could have led to the denial of legitimate claims if I had a medical emergency at some point before the error was sorted out.

I plan to keep a close watch on my account in the future to ensure that there are no problems with my health insurance when I really need it.

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{ 2 comments }

1 Megan January 14, 2009 at 12:43 pm

You should call the claim disput resolution department back and have them send you a letter saying that your file has been cleared, so that this does not come up again in a few more months and turn into a nightmare. Having the letter in your hands would also help you resolve it easily if it were to happen again with the same person.

2 Kacie January 14, 2009 at 1:59 pm

Scary!

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