Fighting Fraud Checklist
Reducing health care fraud is a collaborative effort among Blue Cross and Blue Shield of Texas (BCBSTX), the providers with whom we contract and our members. BCBSTX offers these tips to help you fight health care fraud:
- Understand your own benefits and scope of coverage.
- Review all Explanation of Benefits (EOB) statements. Make sure the exams, procedures and tests billed were the ones you actually had with the provider who treated you. Download Understanding Your EOB .
- 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 BCBSTX 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 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.