We’ve all heard that immigrants may fear giving out personal information to authorities, especially if they, or their loved ones, are here without documentation. But just how widespread is the problem of requiring Social Security numbers (SSNs) as American residents seek health care? I recently had a first-hand taste of what patients deal with every day.

After waiting two months for an appointment, I had my first visit with my new doctor. She came highly recommended as both technically competent and personally compassionate.

I came to the small office and was greeted in the usual manner, given a clipboard of forms to fill out. When I saw they wanted my SSN, I put a line through it. I did give my date of birth, full name, address, employment. The receptionist looked over my forms and said she needed my SSN. I responded that I had been advised by my bank to never give that to a doctor’s office, as identity theft was now hitting medical offices.

I was then told that I simply couldn’t be seen! The computer “required” a SSN to file for insurance. I offered to pay cash for my visit and file my own claim. The receptionist told me I was a “difficult” new patient, and that this doctor didn’t have to see “difficult” patients! I chose to remain and insist upon speaking with the doctor. She did come to the waiting room, and said her own billing system, not the insurance system required the number. How about a fake number, then? Absolutely not! Did I have an emergency at the moment? No. Then I was dismissed until they had a different system.

I did a little research on the use of Social Security numbers. Federally funded migrant, homeless, and community health centers are not to require this data from their patients. Surely, many still do ask for it on old forms. Just asking is often too threatening for a patient to complete the form. States are now coming up with legislation to bar businesses from requiring SSNs mostly due to increasing identity theft. A list of pending legislation is found on: www.ncsl.org/programs/lis/privacy/SSN2007_pending.htm

My own state of Washington composed SB 5323, which says: “Prior to requesting an individual’s Social Security number, all private and public business enterprises must state that the request is not mandatory and that no penalty for withholding this information can be exacted on the individual by the business enterprise.”

Ah, but the proposed Washington state bill did not get out of committee, although I hear they are still trying. I spoke with my state’s attorney general office, who said that until it is a law, private businesses can require SSNs and that my almost-doctor broke no law. Perhaps not, but law and ethics are two different things. What is it worth to us to do the right thing by our patients? What would it really cost to change our billing program to help our patients feel safe in our care? Are billing programs more valuable than the people we serve? So many patients are emotionally laden as they enter a medical office. Must we make that difficult entry even more intrusive and threatening?

I received a polite letter about six weeks after my almost-visit. It said that their billing system still requires a SSN, so that I should go elsewhere. Where is elsewhere for our patients? What are your thoughts on this?