Your Health Insurance Company Isn’t Protecting Your Medical Data or Privacy

The answer is, unfortunately, no.

While both the government and most insurance companies do have regulations and departments to protect your medical data, the truth is that there is still a lot more that can be done. As a result, all the data that your health insurance company has collected about you can still be breached, manipulated, and used to further someone else’s gains. 

Today, we’ll discuss why your insurance company’s current efforts may not be enough to protect you, as well as steps you can take to maintain your privacy.

How does insurance fraud happen?

Healthcare records are easier to access than ever, thanks to digitization. Your healthcare providers and the insurance company can communicate with each other, clearing you for treatments and billing adjustments as necessary.

Many people in a medical office have access to your records, and it’s unsettlingly easy to enter an incorrect code.

Many people have access to your sensitive medical information: doctors, nurses, and office staff, to start. That means there are a lot of hands that could potentially touch and update your records. But because so many procedures and treatments are identified by complex medical codes, these records are easier to manipulate or make genuine mistakes with. When something is miscoded—even if it’s an honest mistake—your insurance company, and often you as a consumer, end up paying more through overbilling.

Even when it’s accidental, this is considered insurance fraud. If it isn’t caught and stopped, you may receive even more inflated bills. Over time, this can lead to permanent changes on your medical record, particularly if you’ve been receiving treatments you don’t need or diagnoses of conditions or diseases you don’t have. This can severely impact the healthcare you receive in the future.

Why doesn’t my insurance company pursue this fraud?

Your insurance company does have a fraud department, but the sad fact of the matter is that the easiest part to track—the amount of money lost to overbilling—remains a drop in the bucket compared to their yearly revenue. If they tracked and pursued each potential fraud case they spotted, they would have to go through the courts, cutting into that yearly profit. 

In one startling case, a personal trainer was able to pose as a doctor and use his 1,000 or so patients to bill millions to insurance companies. Despite frequently using codes associated with complex medical procedures—hence, not something he ought to be billing out for that often—the insurance companies didn’t bat an eye. 

Your medical privacy is in your hands. If you’ve ever looked at an Explanation of Benefits or a bill from your doctor, you’ve probably noticed the codes used. You may even have tried to look them up. Many people just give up at this point because they don’t have the time to decipher the codes and their bills.

How can I protect my medical privacy and data?

In time, additional legislation and operational changes may shift the way insurance companies detect and pursue fraud. Until then, there is still a way to look after your sensitive medical information: HealthLock.

Our proprietary AI technology can detect when your medical data has been tampered with—and we can help you make it right.

We developed our proprietary AI technology to detect the kind of abnormalities that lead to medical overbilling and which can indicate privacy breaches and fraud. It will scan every bill and Explanation of Benefits you receive, ensuring the codes used match up with the healthcare you received. 

What happens when we detect something that doesn’t look right? We flag the issue and get in touch with you. If you’ve been overcharged, or a victim of fraud, we can help you get your money back. Protecting your medical privacy is complicated, but you don’t have to do it alone. Get in touch with HealthLock to see how we can give you a hand.