Health Insurance Fraud

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Years ago, whenever my late father saw news of bad weather in the USA, he’d say “We’ll get it next!” – if the same is true of their reported health insurance fraud, maybe we’d better watch out. The facts seem to be that as long as you take out health insurance and stay healthy, you’re fine. They draw your premiums, you don’t need the care. It’s all perfectly understandable and clear. Everyone’s happy.

The problems start when you need care. In the USA you pay the doctor per visit. If you’re insured, then with most schemes you send in the account to your health insurance company and wait for the settlement cheque. Apparently the next thing that’s likely to happen is that you get a letter from the company saying that the claim is rejected.

At this stage some people back out. It’s not a major amount of money and maybe they’re feeling fine now. It doesn’t seem worth the hassle and so it gets left and the insurance company are feeling better too, having gained, or rather saved, some money for the cost of a letter.

Other people are rather keener to get some of their insurance costs back and follow up the letter by asking the reason for rejection of the claim. Commonly, the insurer issues a form for the doctor to fill in, which you duly take to the doctors and in time the insurer receives it. You hear no more. Again, some people leave it at this, but those that don’t reckon that when they follow it up, the insurer denies having received the form. This may happen a couple of times and must be a major source of annoyance to a busy doctor. Still no cheque is forthcoming. Follow up enquiries usually bring forward the excuse of the doctor filling in the form incorrectly, or using the wrong form. Any old excuse, but no cheque.

The very persistent people probably manage to get a pay-out in the end, but some people, particularly if they lead busy lives, or are unwell are just not able to follow it up and so they lost out

As far as the insurers are concerned they can’t lose by issuing a denial letter. If the insured persons kick up enough fuss, they pay out – but only the amount that they should have paid in the first place – and they’re no worse off.

What is not known is how often this happens – also insurers, unless pushed, don’t tell you why the claim has been turned down.

This, it seems, is the tip of the iceberg. There were a lot more little tricks of the trade exposed in the article. It’s frightening to realize that this fraud is going on, in the name of health care.

As far as the UK is concerned, we’re lucky. Good advice is freely available, from a professional advisor, who knows all about the market in health. It can be found at the click of your mouse. Health insurance can be as comprehensive as you want it to be. Just find an independent insurance broker who’ll come up with some competitive quotes with some reliable companies, where you’ll get exactly what is promised. Read the small print for yourself. Note any exclusion clauses. Fill in any forms with complete honesty. Protect yourself. Get it right, then relax!

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