What Do You Do If You Are A Victim Of Health Insurance Fraud?
Health insurance fraud happens every day and it can be very difficult to protect yourself against it. The majority of plan holders who fall victim to medical insurance fraud are not aware of the fact until they make a claim which is denied and realize that they have joined the growing number of victims of this especially nasty form of fraud.
So, can you stop yourself from becoming a victim of health insurance fraud?
The biggest problem is that there are as many different forms of health insurance fraud as there are victims and so spotting it can be extremely difficult. However, there is one thing that should always raise your suspicions and that is the offer of excellent coverage and a very low price. Medical costs are rising fast and so is the cost of a health insurance plan so, when you are offered a plan at a very low cost, be careful.
Be especially suspicious of unsolicited mail which offers discounted health insurance, particularly if you do not recognize the name of the company which is making the offer. Do a bit of research on the company. You will find that health insurance companies are listed and rated at http://www.ambest.com and you can also check with your State Insurance Commission to see whether the company has been granted a license to operate in your state.
If the offer seems to be genuine then read through it in its entirety and pay particular attention to the fine print. The fine print, which will cover such things as exclusions, may turn an apparently great offer into one which is potentially very costly. If a salesperson calls with an offer then you should also be suspicious of any request that you pay by cash or that you pay the total amount of your premium in advance.
If you find that you are a victim of health insurance fraud then you should take the following steps immediately:
- Contact the State Insurance Commissioner to find out if he has had any other complaints about the company in question and to make a health insurance fraud complaint.
- Get in contact with your bank or credit card company and put a stop on any future payments.
- Contact your local law enforcement agency.
You should also gather up any credit card statements or cancelled checks and a copy of the health insurance contract which you signed, along with any correspondence, to help in the event of an investigation.
Unfortunately this might be the end of the matter but could be just the beginning, as people who perpetrate health insurance fraud will often also use your personal information to steal your identity and to commit other fraudulent acts. So, you also need to get a copy of your personal credit report from all three major credit reporting agencies as quickly as you can and watch carefully for any signs of financial transactions which you have not authorized being carried out in your name.
Be sure and check out any insurance company before you sign on the dotted line. You can never be too careful and, as well as the checks suggested above, you should consider such things as asking others if they have ever heard of the company which has approached you, or which you are considering. This could include asking your doctor or local hospital. If they say that they will not accept health insurance from the company, or indeed that they have never heard of it, then this should certainly set bells ringing.
Carve-out: Specialty health service that an MCO obtains for members by contracting with a company that specializes in that service.
Fully funded plan: A health plan under which an insurer or MCO bears the financial responsibility of guaranteeing claim payments and paying for all incurred covered benefits and administration costs.
Performance measures: Quantitative measures of the quality of care provided by a health plan or provider that consumers, payors, regulators, and others can use to compare the plan or provider to other plans and providers.
Underwriting impairments: Factors that tend to increase an individual's risk above that which is normal for his or her age.
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