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Fraud & Abuse
Fraud is a major concern in the health care industry. It results in a loss of billions of dollars each year, and stress to consumers who are affected by it. 90 Degree Benefits is working to eliminate all instances of fraud that impact our customers, whether it is health care fraud, such as filing false claims, or electronic fraud, such as fake emails and web sites. Your help is needed in this effort. By reviewing the information provided and reporting any instances of suspected fraud, we can work together to ensure the security of our customers’ information and control the rise of health care costs.
Protect Your Identity & Health
You’ve probably heard about the dangers of identity theft - it can damage your credit, your reputation, and cost you time and money to undo the damage. But did you know it can endanger your health and can impact your health negatively.
Why should I be concerned about identity theft?
Identity theft not only causes frustration, anger and stress, it can rob you of your good name and destroy your credit. Victims spend a lot of time and money trying to straighten out issues related to identity theft. It can take months or years to undo the damage.
Here are ways that thieves use the information they steal from you:
- They use your credit card number to make purchases on your account.
- They open new credit card accounts in your name and run up charges.
- When the bills aren’t paid, it shows up on your credit report.
- They get loans for houses or cars in your name.
- They get identification, such as a driver’s license, with your name and their picture.
- They drain your bank account by authorizing electronic transfers or writing counterfeit checks.
- They open bank accounts in your name and write bad checks.
- They file fraudulent tax returns in your name.
- They commit crimes with your name, resulting in warrants for your arrest.
How can I identity theft affect my health?
If someone steals your identity and uses it to receive healthcare services, your medical history could be compromised and result in:
- Receiving the wrong blood type if you ever need a transfusion;
- Getting a medication you’re allergic to;
- Being refused medication or therapy because your medical history shows you have an allergy to it;
- Difficulty getting life or health insurance; and
- Endangering your employment if substance abuse is listed.
What can I do to protect my identity?
Protecting your identity is important for numerous reasons, one of which is safeguarding your health. Nothing is foolproof against the best identity thieves, but by taking a few precautions, you can decrease your chance of becoming a victim.
- Protect your Social Security number. Don’t have it printed on your driver’s license, checks or other materials, and don’t carry your Social Security card in your wallet. Give out your Social Security number only when it’s absolutely necessary.
- Safeguard your Benefits’ ID card.
- Review your 90 Degree Benefits’ Claim Reports to ensure they are accurate.
- Shred paperwork that contains personal or financial information before discarding it. This includes preapproved credit card and loan applications, and materials that include your personal health information.
- Avoid giving out personal information to unknown businesses or people over the phone, through the mail or on the Internet.
- When entering personal or financial information on the Internet, be sure the web site you are using is secure. Look for the lock icon on your browser or https in the web address. This means the site is encrypted and has a security certificate. Also, be sure to install antivirus and firewall software on your computer.
- Don’t click on links in unsolicited emails.
- Destroy expired credit and ATM cards.
- Order an annual copy of your credit report and review it for discrepancies.
- Review bills, bank statements and other financial accounts for suspicious activity.
What should I do if I’m a victim of identity theft?
If you suspect that your information has been stolen, follow these steps immediately:
- Place a “Fraud Alert” on your credit reports and review them carefully. This will make it harder for thieves to open accounts in your name or alter existing accounts. Call any of the three nationwide consumer reporting companies to put a fraud alert on your credit report:
Equifax: 1.800.525.6285
Experian: 1.888.EXPERIAN (397.3742)
TransUnion: 1.800.680.7289 - Close any accounts that you suspect have been tampered with or opened fraudulently. Speak with someone in the security or fraud department. Follow up in writing, including copies of supporting documents. Keep the original supporting documents with copies of your letters in your files.
- File a police report. This will come in handy if creditors require proof of the crime.
- Report the theft to the Federal Trade Commission (FTC). This helps law enforcement officials investigate identify theft and increases the chance of stopping the perpetrators.
To file a report with the FTC:
Visit: www.ftc.gov/idtheft.
Call: 1.877.ID-THEFT (438-4338).
Send a letter to:
Identity Theft Clearinghouse
Federal Trade Commission
600 Pennsylvania Avenue, NW
Washington, DC 20580
For medical identity theft:
- Contact your healthcare provider and request the correction of false claim and medical history.
- Notify your health insurance company of the incident.
- In addition to filing a police report and reporting the incident to the FTC, report it to the Social Security Administration and Medical Information Bureau.
Additional resources
- Federal Trade Commission: www.ftc.gov/idtheft
- World Privacy Forum: www.worldprivacyforum.org
- United States Postal Inspection Service: postalinspectors.uspis.gov
- Identity Theft Resource Center: www.idtheftcenter.org
- Privacy Rights Clearinghouse: www.privacyrights.org
- Social Security Administration: www.ssa.gov
- Medical Information Bureau: www.mib.com
How to Identify Fraud & Abuse
Insurance fraud costs you money in the form of higher health care costs. In fact, losses to fraud account for an estimated 10% of what’s spent on health care annually. At 90 Degree Benefits, our associates are dedicated to stopping fraud. However, we still need help from people like you.
Helping 90 Degree Benefits uncover fraud is easy. All you have to do is:
- Know what to look for
- Keep watch
- Report suspected fraud and abuse
What to Look for
Common types of health care fraud include:
- Filing false claims or billing services that were not performed—when policy holders or medical care providers submit claims or bill services to receive payment for services that weren’t provided.
- Including misleading information in an application for coverage—a person lies about a relationship to a contract holder or deliberately gives incorrect information to receive benefits not entitled to.
- Using ID cards that belong to someone else—using another person’s insurance ID card to receive or pay for services one isn’t eligible for.
Keeping Watch
- Read any Explanation of Benefits (EOB) you receive carefully
- Take note if you seem to be paying unusually high charges for regular services
- Understand what services your benefits provide fo
Report Suspected Fraud and Abuse
We need your help in identifying cases of fraud and abuse. After all, only you know the services you received. If you see something on an Explanation of Benefits (EOB) that doesn’t look right or if it lists a service you don’t think was performed, contact your doctor or health care provider to question it.
If you still have questions or concerns after talking to your provider, complete the online form to report suspected fraud and abuse or call our fraud hotline at: 1.800.824-4391.
How to Identify Fraudulent Emails
NEW Fraudulent Email Alert!
90 Degree Benefits has received reports that some customers are receiving fraudulent emails that appear to be from 90 Degree Benefits. Legitimate emails sent by 90 Degree Benefits will never ask you for your password, social security number, contract number or other personal information, or threaten to cancel your insurance.
Avoid Being a Victim of Phishing Scams
The purpose of phishing emails is to steal your identity or personal information. These emails may imitate the logos, style and language used by 90 Degree Benefits. Protect yourself from these scams by learning to identify them.
Look for the following:
- Generic greetings or mistakes in the greeting.
- A false sense of urgency. Many phishing emails threaten you to act immediately to avoid losing access to your account or cancelling your contract.
- Misspellings and bad grammar.
- Pop-up boxes in an email are not secure. If a pop-up box appears simply by opening an email, do not enter personal information into it.
- Links in the email that go to web sites other than 90 Degree Benefits’ sites.
If you receive a suspicious email that you would like to report, please contact our Customer Service department. View our Privacy Statement.
Report Suspected Fraud & Abuse
Please call our fraud hotline at 1.800.824.4391 or complete the following form if you suspect an incident of fraud or abuse has occurred
HIPAA Privacy Notice
A major goal of the HIPAA Privacy Notice and 90 Degree Benefits is to assure that individuals’ health information is properly protected while allowing the flow of health information needed to provide and promote high quality health care and to protect the public’s health and well being.
What is HIPAA?
HIPAA, which stands for the Health Insurance Portability and Accountability Act of 1996, has two primary purposes:
- To protect health insurance coverage for workers and families when they change or lose jobs and
- To provide a framework for administrative simplification in health care.
90 Degree Benefits is dedicated to both of these efforts.
Privacy Statement
Legal Disclaimer
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing”. This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.
You are protected from balance billing for:
Emergency Services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
Fraud is a major concern in the health care industry. It results in a loss of billions of dollars each year, and stress to consumers who are affected by it. 90 Degree Benefits is working to eliminate all instances of fraud that impact our customers, whether it is health care fraud, such as filing false claims, or electronic fraud, such as fake emails and web sites. Your help is needed in this effort. By reviewing the information provided and reporting any instances of suspected fraud, we can work together to ensure the security of our customers’ information and control the rise of health care costs.
- You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact the No Surprises Help Desk at 1-800-985-3059 from 8 am to 8 pm EST, 7 days a week, or submit a complaint online at https://www.cms.gov/nosurprises.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Transparency
As the administrator of your health plan, 90 Degree Benefits is here to guide your organization through the requirements of the Transparency in Coverage Rule, so we are introducing useful tools to assist with compliance.
Machine Readable Files (MRFs)
Users can access and download 90 Degree Benefits’ Machine Readable Files (MRFs) that disclose the costs of in-network rates, out-of-network allowed amounts and billed charges.
Coverage of any item or service in the files is subject to the terms, limitations, and conditions of the member’s contract. Always check the member’s benefits for coverage information and limitations. Rates could change subject to participant, beneficiary, or enrollee-specific characteristics.
Price Transparency Tool
Available January 1, 2023
90 Degree Benefits’ CAA Price Transparency Tool makes it easy for members to access personalized cost-sharing information for health services from any participating provider. Access the details you need to help make decisions for your healthcare in three easy steps outlined in the guide below.
Download CAA Price Transparency Tool Guide
If you have any questions, please contact us.
Gag Clause Attestation
Part of the Affordable Care Act includes a Prohibition on Gag Clauses concerning price and quality information in provider agreements. For your convenience, we have provided a step-by-step guide on how to complete this requirement along with the FAQs from the CMS website.
Beginning December 31, 2023, and annually thereafter, group health plans and health insurance issuers offering group or individual health insurance coverage must submit a Gag Clause Prohibition Compliance Attestation. Download the below guide which will provide guidance on completing this requirement.
Please refer to the FAQ document below which is from the CMS Government website and contains answers to common questions pertaining to the Gag Clause Prohibition Compliance Attestation.
90 Degree Benefits understands the importance of transparency and the need for individuals to have access to information about the cost and quality of care they receive. We aim to empower our participants and beneficiaries to make informed decisions about their healthcare options by eliminating any barriers to sharing this crucial data.
If you have any questions, please contact your local office.