As the economy worsens, health insurance premiums are rising and people are looking for the best rate health insurance. However, with this increase of people exploring more options for health insurance, there’s been an increase in fraudulent insurance companies as well. There are certain red flags one should look for before signing with a health insurance company.
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According to the Texas Department of Insurance, health insurance fraud is when an adjuster, health care provider, company or agent deceive or misrepresents facts for insurance coverage in order to receive a profit. Luckily, there are many states that put up preventative measures in order to protect consumers against health insurance fraud. For example, Texas does not allow companies to sell insurance without a license.
Types of Health Insurance Fraud
Unlicensed insurance is one of the worst schemes a person can fall prey to. Those companies who are not licensed don’t meet their state’s financial requirements. In most cases these health insurance companies do not have money to pay out for claims.
These companies will nonetheless collect on premiums and may pay out some of the smaller health insurance claims. However, when bigger claims come in these companies tend to disappear and leave that individual with expensive bills to pay and no health insurance coverage.
Many of the unlicensed insurance companies will target businesses and try to sell their insurance policies. Since businesses are looking to cut costs wherever possible, the unlicensed insurance companies may be able to sell their product by saying they are part of a trust or trade union.
Those health insurance companies who say they are exempt from state regulation are the ones to look out for. While there are types of insurance that are exempt from state regulation, these plans are usually created by a business or organization to cover their own employees or members.
There are even employees who commit insurance fraud. Some employees will mislead employers and the health insurance companies about work related injuries in order to receive benefits.
What usually happens is an employee will report an injury that is not work related, and will exaggerate the extent of the so-called injury. There are some medical providers and lawyers who will aid in helping the employee so that they can profit from unnecessary services.
What are the Red Flags for Fraudulent Insurance?
- rolling lab schemes
- services not performed schemes
- Medicare fraud
- medical equipment fraud
There are some red flags to look for. For Medicare fraud, the elderly are usually the ones targeted for these schemes. Some of these companies will offer medical equipment in exchange for their Medicare numbers.
Doctors need to sign off on the equipment before Medicare will pay for it, but there are plenty of con artists or corrupt doctors who will fake signatures. After the con artist receives the Medicare numbers they will bill Medicare for the merchandise and services without ordering it for the client, or for a client who doesn’t need the equipment.
Insurance providers or health care providers in some cases will change bills and/or submit fake ones in order to take money from their customers. There are also frauds where fake and unnecessary tests are given to people in several settings such as retirement homes, health clubs and shopping malls. They then bill the insurance companies or Medicare for these unnecessary tests.
Ways to Avoid Fraudulent Health Care or Health Insurance
There are many schemes out there and preventing yourself from being taken advantage of is extremely important. If something sounds too good to be true it usually is. Any inexpensive health insurance companies which claim to give you premiums much lower than what you’re finding normally should always be given a thorough inspection before you sign on the dotted line.
Other ways to prevent yourself from being taken advantage of are pretty straightforward and simple.
- Don’t give up your medical insurance information or Medicare identification to anyone you are not sure of- even if they claim to be a medical provider. Only give it to those who have actually provided you with medical services.
- Don’t do business with sales people who go door to door. If they say their services or medical equipment is free, chances are it is not.
- Review any insurance policies benefits statements thoroughly before signing and make sure you’re working with the best health insurance companies to meet your needs.
- Ask your medical provider what they are billing to the insurance company and how much you are required to pay out of pocket. This should be easy information to find; if your medical provider doesn’t know, they should have someone look into it.
By following some simple steps you can prevent yourself from being taken advantage of. To find FREE health insurance quotes that are safe and from a reliable source, simply use your ZIP code and start searching here!