Fighting Fraud Checklist
Reducing health care fraud is a collaborative effort between Blue Cross and Blue Shield of New Mexico (BCBSNM), its providers and its members. BCBSNM offers these tips to help you fight health care fraud:
- Understand your own benefits and scope of coverage.
- Review all Explanation of Benefits (EOB) forms. Make sure the exams, procedures and tests billed were the ones you actually had with the provider who treated you.
- Understand your responsibility to pay deductibles and copayments, and what you can and cannot be balanced billed for once your claim has been processed.
- Guard your health insurance card and personal insurance information. Notify BCBSNM immediately if your card or insurance information is lost or stolen.
- Sign and date only one claim form per office visit.
- Never lend your member ID card to another person.
- Don’t give out insurance or personal information if services are offered as "free." Be sure you understand what is "free" and what you or your employer will be charged for.
- Ask your doctors exactly what tests or procedures they want you to have and why. Ask why the tests or procedures are necessary before you have them.
- Be sure any referrals you receive from your network provider are to other network doctors or facilities. If you're not sure, ask.
- Are you a member? If so, you can monitor your prescription utilization through Blue Access for MembersSM or your Pharmacy Benefit Manager (PBM). Make sure the medications billed to your insurance are accurate.
- Be wary of fraudulent sales pitches involving the recent national health care legislation (Patient Protection and Affordable Care Act), such as obtaining coverage in a non-existent "limited enrollment period" that marketers falsely claim was made a part of the legislation. Do not disclose your membership information to such marketers.
