DEKALB COUNTY, Ga. — Hospital stays, surgeries, and treatments have racked up more than $200,000 in medical bills charged to a DeKalb County man’s health insurance. The problem is it wasn’t him.
It’s a personal identity mix-up that Richard Adams and his wife Kimberly say is a financial and health risk for Richard and whoever it is getting medical treatment, as Richard.
“You’re paying for services that my husband did not receive. And then now this other person’s medical records have been intertwined with his,” Kimberly Adams told Channel 2 Consumer Investigator Justin Gray.
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The Adams first learned of a problem more than a year ago when a nurse called to check in to see how Richard was doing after a hospital stay he never had.
“She told me the dates, and I said, no, ma’am, he couldn’t have because he was at dialysis on those days,” Kimberly Adams said.
But Richard Adams’s Aetna statement contained dozens of charges related to a heart surgery and recovery.
“I thought it was incredible. Especially when there have been times, I’ve been denied coverage. And here they’re covering things that I’ve never had done,” Richard Adams said.
And it is not just the bills being mixed up. So are medical records. Richard Adams does not have heart problems but does have failing kidney function.
“We’re trying to get him on the kidney transplant list. And, they started saying, well, we need to talk to you about this, stent you have in your heart, and this implanted defibrillator. And he’s like, I don’t have either of those,” Kimberly Adams said.
For months, the couple went back and forth between Aetna and the hospitals about those first charges that ran 6 figures. They thought the problem was sorted out. Then this summer, there were more phone calls and more charges.
“How’s anybody’s medical information floating around out there like that?” Kimberly asked.
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Aetna tells us in a statement:
“Aetna is committed to accurate and appropriate claims payment for medical services for our members. We have identified the claims that were submitted in error by the provider, and we are working with them to remove these claims, since the member has no medical bills associated with them.”
“You have to provide your insurance card and your driver’s license when you get medical care anywhere. So how can they be using my husband’s insurance without his card? That’s what doesn’t make any sense,” Kimberly Adams said.
The Adams have been told it could be as simple as the other patient having the same name and date of birth. But the problem has continued for nearly 2 years now.
Channel 2 reached out to St. Mary’s Medical Group where many of the charges originated but they have not responded.
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