Everyone recognizes that the health insurance cover industry is continually raising monthly premiums, and many feel this is unjust to you as the consumer. Even so, the health insurance cover industry has had to fight increasing health insurance cover fraud. The sum of money used on investigating and prosecuting fraud is then passed on to policyholders. Many people do not know what health insurance protection fraud entails, though. With incidents estimating health insurance deception is a $30 billion to over $100 billion industry each year, the topic ought not to be taken lightly. Every health insurance protection policyholder should know what health insurance cover 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 details to receive benefits from the insurance company. Essentially this means that you assert that you paid certainly medical operations or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance underwriter to receive reimbursement. Another instance of member fraud is to hide prior conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits below your policy. Perhaps your sister doesn't have insurance and requires medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may consider that this is a small issue compared to your sister receiving treatment, it is really extremely serious to your health insurance cover 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 underwriter for services they cater to you, they are also receiving reimbursement from the insurance firm. When providers commit fraud, they may be billing the underwriter at higher rates for services rendered or they may bill for services you never received. In these instances, you will likely be asked to cooperate in the insurance company's investigation.
Another sort of health insurance fraud that has developed recently targets the policyholder more than the insurer. Schemes have obtained where fake insurance businesses or agents sign unsuspecting customers for insurance coverage at surprisingly low premium rates. They often act much like a regular insurance underwriter for the initial few months, paying for smaller medical claims like physicians visits. But once you've a more severe medical problem that needs treatment, the underwriter will disappear - along with the cash you have been repaying in premiums.
The rule with health insurance deception is much like that of any other scam: if a deal seems fantastic, simply remember - it in all probability is. Remember to be truthful in your dealings with health insurance cover businesses and expect the same in the return from all of these companies, as well as your healthcare providers. Stay legal to avoid fines and prison and to continue receiving health insurance cover coverage.
Health insurance fraud is typically defined as intentionally deceiving, misrepresenting, or concealing details to receive benefits from the insurance company. Essentially this means that you assert that you paid certainly medical operations or expenses out-of-pocket which you have not actually received, and you are submitting claims to the insurance underwriter to receive reimbursement. Another instance of member fraud is to hide prior conditions or to alter medical documents so that non-policyholders or ineligible members receive medical benefits below your policy. Perhaps your sister doesn't have insurance and requires medical attention. Having her use your name and policy to cover the expenses is health insurance fraud. While you may consider that this is a small issue compared to your sister receiving treatment, it is really extremely serious to your health insurance cover 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 underwriter for services they cater to you, they are also receiving reimbursement from the insurance firm. When providers commit fraud, they may be billing the underwriter at higher rates for services rendered or they may bill for services you never received. In these instances, you will likely be asked to cooperate in the insurance company's investigation.
Another sort of health insurance fraud that has developed recently targets the policyholder more than the insurer. Schemes have obtained where fake insurance businesses or agents sign unsuspecting customers for insurance coverage at surprisingly low premium rates. They often act much like a regular insurance underwriter for the initial few months, paying for smaller medical claims like physicians visits. But once you've a more severe medical problem that needs treatment, the underwriter will disappear - along with the cash you have been repaying in premiums.
The rule with health insurance deception is much like that of any other scam: if a deal seems fantastic, simply remember - it in all probability is. Remember to be truthful in your dealings with health insurance cover businesses and expect the same in the return from all of these companies, as well as your healthcare providers. Stay legal to avoid fines and prison and to continue receiving health insurance cover coverage.
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