Stay Legal! Avoiding Insurance Fraud

Everyone knows that the health insurance industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. However, the health insurance industry has had to fight increasing health insurance fraud. The amount of money spent on investigating and prosecuting fraud is then passed on to policyholders. Many people do not understand what health insurance fraud entails, though. With reports estimating health insurance fraud is a $30 billion to over $100 billion industry per year, the topic should not be taken lightly. Every health insurance policyholder should understand what health insurance fraud is and its consequences. By doing so, you are more able to recognize and fight fraud.

Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing information to receive benefits from the insurance company. Essentially this means that you assert that you paid for certain medical procedures or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance company to receive reimbursement. Another example of member fraud is to conceal pre-existing conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Perhaps your sister does not have insurance and needs medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may think that this is a small issue in comparison to your sister receiving treatment, it is actually very serious to your health insurance company and industry, and will result in fines and possible imprisonment if your are caught.

Not only policyholders commit fraud, but providers (physicians, hospitals, etc.) do as well. Since physicians and hospitals bill the insurance company for services they provide for you, they are also receiving reimbursement from the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for services rendered or they may bill for services you never received. In these cases, you will probably be asked to cooperate in the insurance company's investigation.

Another type of health insurance fraud that has developed recently targets the policyholder more than the insurance company. Schemes have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premium rates. They often act much like a regular insurance company for the first few months, paying for smaller medical claims like physicians visits. But once you have a more serious medical condition that needs treatment, the insurance company will disappear - along with the money you have been paying in premiums.

The rule with health insurance fraud is much like that of any other scam: if a deal seems too good to be true, just remember - it probably is. Remember to be honest in your dealings with health insurance companies and expect the same in the return from these companies, as well as your health care providers. Stay legal to avoid fines and prison and to continue receiving health insurance coverage.

The Importance of Good Records

Keeping your own records of any medical care that you and your immediate family have received is the only way to be sure that your insurance and bills are free from mistakes. It may seem unimportant now, but later in life when you try to get life insurance or get treatment that is appropriate for you, the importance will be in the spotlight. Everything from your allergies to your payment records with medical facilities can hurt you if they are wrong in your report. You could be given improper treatment or even denied treatment at all. By keeping your own records, you can dispute anything that is false.

Would you believe that you could be denied a job because of something erroneous on your medical records? It is true; if you are reported to have a disability, whether it is true or not, you could be turned down. You would be labeled as a risk, especially if the company offers insurance; they would know that you are going to cost more money to employ. The same goes for applying for health insurance where your medical records show that you would require prescription drugs, doctor visits, and increased chance of emergencies. It is quite the ordeal if you do in fact have a disability, but imaging if you did not have one at all-you would be turned down for insurance, while also being completely ineligible for disability financial help.

An example of a mistake that could be made on your record would be a diagnosis error. Perhaps you request that your doctor check a suspicious lump in your breast. On the first visit he may suspect that it is cancer. Most people will get a second opinion or go for a more thorough conclusive examination. If the second doctor decides that it is only a cyst and has it removed, your personal records would show that you are cancer-free. However, if this visit was documented incorrectly, or not at all, you may have trouble getting insured and not know why. If you had a record of the second visit that found the cyst, this situation would be easily disputed and your record would be accurate.

Human error is simply a part of life, even on medical documents. It is important to always keep your own records so that insurance companies get accurate information about you and your health condition. If you are being turned down for insurance and do not know why, you are best advised to be sure that you are not being misrepresented within your medical records. This problem can be cleared up quickly and easily if you are responsible enough to keep your own personal records.

Traveling Alternative Roads: Other Options for Health Care

Health insurance can be expensive if you are not lucky enough to have it provided by your employer. Even shopping around for the best quotes may not be within your budget. Luckily there are alternatives to health insurance that you can take advantage of so that you and your family will be safe even if an emergency situation comes up. You can apply for the prescription discount card program, which is a low monthly cost and works at most of the of corporation drug stores that we all use. There are also programs that give you health care but are not considered "health insurance".

The prescription discount card is great for anyone who has regular prescriptions that need to be filled over a long period of time. The cost of prescriptions without insurance is high and always rising. If you cannot afford health insurance, there is no way that buying these full priced prescriptions will come without difficulty. You can enroll in a discount card program on the Internet or you can call around to try and find one locally. The reported savings for each person is estimated to be at least 50%, and some programs will enroll you for under $5 a month.

Health care programs are another popular alternative to expensive health insurance. BeniCard, for example, is a highly acclaimed health care program, and for a small monthly fee, you can have your immediate family covered. You will not be turned down because there is no limit to who is eligible, even if you have a pre-existing condition. It is not health insurance, but you will be able to save money on doctor visits, vision and hearing care, dental services, and prescription drugs. This is just one of the programs that can help you if you cannot get health insurance due to expense or because you have been turned down due to an illness.

No one should go without health care of some sort. Prescriptions are extremely costly without insurance, and if you or someone in your family has an emergency health situation, you could be left with a large debt for years. Insurance companies are hesitant to accept anyone with a pre-existing illness because it will definitely cost them plenty of money. For anyone who has been turned down for health insurance or simply cannot afford to pay a deductible, health care programs and prescription discounts are a low-cost alternative that could save you money.

Ways of Paying for Health Insurance

When it comes to health insurance, many people don't exactly know everything that there is to know about the subject. That only stands to reason, it is not something that is easily understood because of its complexity. For instance, when you visit the doctor you may be asked to pay something that is called the "co-pay", and other times you may not have to do anything at all depending on your plan. Let's look at some of the ways that health insurance is paid for.

Often times, your employer will sponsor your insurance and you only have to pay what is known as a "co-pay" or co payment. The co-pay is a set amount that is determined by your insurance company when you receive covered services. This is a significantly smaller fee than you would be paying without the co-pay. Many companies offer this type of payment option because it is easier on the employee to pay this way.

You may consider opening what is known as a Healthcare Savings Account (HSA). This will assure that you always have a location in which to retrieve payments for various medical expenses. The HSA is a pre-tax savings account where a portion of your pre-tax income, determined by you, is deposited into an account automatically. Since this account comes from your paycheck pre-tax, that means it will lower your overall taxable income. This means you are saving money in terms of taxes and saving lots of money towards your overall health care costs.

For certain disabled individuals and those above the age of 65, Medicare is also another way to pay for health insurance. While they will not pay all of your healthcare expenses, they will pay for most of them. Medicare, however, doesn't cover prescription drugs and nursing homes. It is important that you check the different types of restrictions that may apply. There are low-cost prescription discount cards that have been proven to save people who require costly medications on a regular basis over 50% of what they would have been paying without any health care.

Paying for health insurance doesn't have to be complicated as long as you understand just what is going on in terms of where you stand with your plan. Discuss any questions you may have about the plan before committing to one. While one plan may be right for many people, it does not always mean that it will fit your specific needs.

What are HIPAA Laws?

Your visit to the doctor now contains a page where you sign that you acknowledge that the physician's office has notified you about their compliance with HIPAA laws. More often than not, you probably read through quickly or barely skim the authorization form before signing it. However, HIPAA laws are important, and they are in place to protect you from identity theft, being denied care, and/or health insurance coverage.

HIPAA stands for the Health Insurance Portability and Accountability Act, enacted in 1996. HIPAA laws created a new national standard in protecting your health information. As you see different physicians or become admitted to different hospitals, your health information should follow you. HIPAA delineates the need to properly protect your health information as it flows through to these different channels. As more and more transactions are completed electronically these days, HIPAA laws focus on the protection of your health information specifically through these channels.

So what does HIPAA protect? For you, HIPAA protects personally identifiable health information, such as your Social Security number, birth date, address, etc., as well as current, past, or even future physical and/or mental conditions or treatment. Such information may not be disclosed except for specific uses. Information that HIPAA does not cover must specifically be personally non-identifiable. In protecting this sort of information, there is more protection against identity theft and more recourse if such a thing should happen.

HIPAA also protects how health insurance providers may use your health information. These entities may use your information without your authorization only if they are sending you information, using this information to provide the best treatment or health care, or collecting payment on medical expenses, among other things. If disclosure of your health information does not fall under these categories, you must authorize the transfer of information in writing. Furthermore, because the government understands that highly technical language can be a barrier in understanding your health information privacy rights, any authorization must be in plain language.

This may all seem like unnecessary paperwork, but beyond identity theft, HIPAA laws also help those looking for health insurance coverage. Title 1 of the HIPAA laws oversees the availability and range of health insurance plans for those without perfect health. It outlaws any health insurance plan from creating discriminatory rules to create premium rates or deny coverage. HIPAA laws are quite extensive, but this gives you a look at how your health information is being protected and used. Your department of health should be able to give you further information, or you can search the government's Web site for the entire HIPAA law.