Woman’s health insurance paid another person’s bills for three years

If there was ever a lesson in why you should read your insurance statements: this is it.

Mary Godfrey said she is very diligent about reviewing all of her explanation of benefits summaries from Florida Blue, and in 2018 something jumped off the page.

There were claims paid to a podiatrist and a physician’s assistant at a “domiciliary home”.

“I’ve never been in a nursing home,” said Godfrey.

When she called the providers listed, she discovered that someone with her same name and date of birth had received this care and somehow got attached to Godfrey’s Medicare supplement plan with Florida Blue.

According to Godfrey, Florida Blue told her the charges would be reversed and the issue resolved. But for three years, claims paid for the other Mary Godfrey continued to show up on her insurance statements.

Florida Blue would not discuss the situation with WINK News. Only one provider, Bayfront Venice, responded to inquiries.

A spokesperson for the hospital system said their records indicated that they billed the correct person for an ER visit.

But Godfrey insisted that she had never been to that emergency room, never been transported by ambulance from that hospital and certainly had not spent any time in a nursing home.

“That’s why I called WINK News to help me because it’s out of control now, it’s like what do I do now?” said Godfrey.

According to public records, the other woman died in August 2020. Godfrey’s explanation of benefits from that timeframe show claims shortly before her death.

“There’s a lot of people with same and similar names and same date of birth sometimes, so it’s not very hard to mix up a patient if you’re not paying attention,” said Tiffany Drake, a billing supervisor not connected to the situation.

Drake agreed to review the statements for WINK News to provide some explanation.

In her experience, she said insurance benefits are verified by date of birth when an insurance card is not available.

That verification happens through a third-party system and those benefits would stay attached to a patient as they are transferred and referred between hospitals and doctors.

“If someone’s asking us to see a patient and they send us the patient’s information we use that information. If it’s wrong and somebody doesn’t verify it when the person gets here, then we’re going to continue to use that wrong information until someone brings it to our attention,” she said.

Drake said she was surprised that Godfrey’s issue persisted for so long, even after she informed the providers and the insurance company of the issue.