Well when a patient does not pay their bill in full or a balance is left after insurance has paid and it is carried on the books that puts us in the position of "creditor". Therefore we fall under the auspices of the Red Flag Rules. However, that aside we are also responsible for making sure that the person who says they want to see the doctor is indeed that person. The only way to certify this to the best of our ability is to ask you the patient for your photo identification and other information that is applicable only to you. When we make a copy of your photo identification we put it into your medical file along with a copy of your insurance card. We also ask you to fill out what is called a demographic sheet, which asks for your address, telephone number, workplace, work number, person to be contacted in case of emergency, allergies, past surgeries, medications, physical history and so on.
This is to ensure that the next time someone comes in stating your name we will have something to compare with what we have on file with the information that is being given to us at check in. We will also ask you to give this information again if you tell us that there has been a change in your information or you have not been in a while or it has been longer than 3 years.Let me explain to you what can happen, has happened, and happens all too often in medical practices, labs and even hospitals all over the United States if your information cannot or has not been confirmed.
Let's say Sally Medidtheftster comes into the doctor's office, she signs in writing your name which for example is Patsy Wouldnotshowphotoid. I do not have a photo identification in the medical file for you Patsy Wouldnotshowphotoid. Somewhere, somehow Sally Medidtheftster knows additional information about you. Since I have no idea what you, Patsy look like, I have to assume that Sally is you. Now I take Sally back to the exam room. After Dr Unaware examines and runs lab tests on Sally who is pretending to be you, he discovers that Sally who is pretending to be you is Diabetic or has a sexually transmitted disease. Now this information is going to be put into your medical record. Yes I know it is not you but I had no way of determining who Patsy really was so I ended up putting all that incorrect medical information into your, Patsy's record.
Okay do you see where I am going with this? Now the real Patsy-who is you, comes in for a doctor's visit and suddenly she is asked if she has checked her blood sugars. You, Patsy respond with "what are you talking about I am not diabetic?" Then I have to say, "but you were just in a few months ago and we tested you and your labs came back positive for Diabetes."
Do you really expect me to know who you are? I see many patients daily. What if I am a new employee with this medical practice? However if I had a picture of you in the folder along with other personal identifiers, I would have known in the beginning that Sally was not you. Now on top of this confusion we not only have treated a person committing fraud (on your insurance I might add) we have entered incorrect medical information in your file. I could take it one step further and give you an example of what would have happened if you the real Patsy had been taken to the emergency room because of a car accident and our office had been contacted for your medical records. Your records show you are diabetic. So perhaps the reason for your confusion is not because you bumped your head on the dashboard in the car accident but because your sugar is low and according to your records; you have been prescribed insulin. Now the emergency room doctor gives you insulin per your medical records. Except oops you are not diabetic, that was Sally's information not yours. Except it is in your medical records! Now you are in a coma. Oh me oh my who is at fault? Is it the doctor for believing the information in your medical records? Could it be because you refused to cooperate at the front desk when asked to give information we needed so that we could protect your medical identity. Could it be that if we had a picture of you we would have known that the 5' 4", 267 pound blond who came in a few months ago was not the same 5'5" 250 pound brunette lying in a coma now? Yes it is an exaggeration but it could happen. Little things like comparing addresses, insurance information, pictures and other personal information can go a long way in helping us the medical practice protect you, the patient from this kind of scenerio.
There are numerous cases of uninsured patients being treated with someone else's insurance benefits. There are numerous cases of uninsured children being treated pretending to be the insured child of an insured subscriber. Imagine the time and money wasted correcting these kinds of mistakes. But more than anything imagine the lives that could be injured or lost because of incorrect medical information. So please don't be a Patsy Wouldnotshowphotoid. Do not ask us to make exceptions for you. Please do not ask our doctors to risk being fined for breaking the law.
Help us the medical office protect you and your medical identification and catch all those Sally Medidtheftsters! Oh Sorry Sally we need to catch those Johnny Medidtheftsters too!
http://www.ftc.gov/bcp/edu/pubs/business/alerts/alt050.shtm
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