Health Insurance Fraud: What You Should Know

Health insurance fraud represents one of America's largest taxpayer rip-offs ever, costing Americans literally billions of dollars every year.

Due to rampant deception, scams and abuse in the health care system, consumers are forced to pay the price--literally--through escalating medical costs and rising health insurance premiums.

And government programs like Medicare and Medicaid, designed to help the low-income and elderly, represent two of the biggest losers of all.

Health Insurance Scams

According to the Insurance Information Institute, health providers and facilities such as doctors, hospitals, nursing homes, diagnostic labs and attorneys routinely attempt to defraud the health insurance system...with devastating results.

How do they do it? In a number of ways, including:

    Billing health insurance companies for expensive treatments, tests or equipment patients never had or never received

    Double- or triple-billing health insurers for the same treatments

    Giving health care recipients unnecessary, dangerous, or life-threatening treatments

    Selling low-cost health insurance coverage from fake insurance companies

    Stealing medical information and using it to bill health insurance companies for phantom treatments

If health insurance fraud knocks on your door, these types of scams may leave you with medical debts, damaged credit ratings, falsified health records, a high level of stress and overpriced health insurance premiums...or the inability to get any health insurance at all.

So what can you do about it?

Report it; then fight back!

What to Watch For

The first step to fighting health insurance fraud is keeping your eyes and ears open for abuse.

Be especially watchful for providers who:

    Charge your health insurance company for services you never received or medical procedures you don't need

    Give you prescriptions for controlled substances for no justified medical reason

    Bill your health insurance company for brand-name drugs when you actually get generics

    Misrepresent cosmetic or other health care procedures not usually covered by health insurance plans as covered

If you notice a health care provider doing any of these things, keep all supporting paperwork handy for reference, and then contact your health insurance company to let them know.

Then, if you're a Medicare or Medicaid recipient, call the U. S. Department of Health and Human Services and report the abuse.

Finally, contact your state department of insurance or the local police.

Fighting Health Insurance Fraud

To keep yourself from falling victim to health insurance fraud, take the following steps to fight back:

* Check with your state insurance department to make sure your health insurance company is licensed in your state.

* Check out your health insurance company for consumer complaints, fraud convictions and bankruptcies through your state department of insurance.

* Keep detailed medical records.

* Carefully review your billing statements.

* Never sign blank insurance claim forms.

* Avoid salespeople offering free health services or advice.

* Protect your medical records and information.

* Make sure you know what your health insurance policy covers--and what it doesn't.

* Never pay your health insurance premiums in cash.

* Be wary if you're asked to pay a full year's premium up front.

* Be on guard against medical providers claiming to be connected with federal programs or the government.

* Beware of health insurance companies offering you coverage at an unreasonably low price.

* Ask your health insurance provider about anything you don't understand regarding your bills.

Making a Difference

Protect your right to health insurance, lower your premiums and keep your medical information safe. All it takes is a little education, a watchful eye, and the willingness to make a difference!

Student Health Insurance - Tips to Help You Choose the Right Policy

It is summer 2006. Young and not so young people are graduating from school and there are millions of people who are starting to think about student health insurance. Here are some tips for parents and students who are looking for health insurance for a college student, health insurance for a graduating college student or health insurance for an older graduate student. There are a lot of choices. This article is designed to give you an overview of the choices available to students.

Health Insurance For College Students You should explore all of the medical plan options available to you. Your choices may include:

•  Getting health insurance through the student's employer.
•  Getting medical insurance through your local Blue Cross Blue Shield or other private health insurance plan.
•  Getting "college student health insurance" through a plan offered by their college or university.
•  Getting health insurance as a dependent on the policy of a parent or spouse.

When looking for the non-group health insurance plans that are available in your area, you may want to contact your state's insurance department. You can contact them and find out which companies market individual health insurance in your area. Healthcare choices for the out-of-state student If you live on campus, look into the plans offered in each area. If your parents live in Florida, but you go to school in Texas, you should see what health insurance plans are available to you in both states. A student who has a permanent address of Connecticut and attends Yale in New Haven should only purchase a Connecticut-approved plan. If the same student transfers to UCLA, he or she can also explore plans offered in California. Some plans may even charge differently based on your zip code, so even if your two addresses are in the same state, you may still save money by looking at rates for both areas. Health Insurance For A Graduating College Student You should explore all of the medical plan options available to you. Your choices may include:

•     Getting health insurance through the former student's employer.
•     Getting medical insurance through your local Blue Cross Blue Shield or other private health insurance plan.
•     Purchasing short-term health insurance to cover you until your employer-sponsored plan becomes effective.
•     Getting health insurance as a dependent on the policy of a parent or spouse.

Medical Insurance Plans to Watch Out For:

•    Discount plans. These are not health insurance plans! These plans can save you money on health care, but only offer discounted services and not true insurance benefits. If you had a major accident or sickness, getting 25% off of a healthcare bill of $50,000 may not give you the benefits you hoped for.
•   Accident only plans. Students get the flu, mono and even cancer. Being covered with an accident only plan can offer substandard coverage when compare to a comprehensive health insurance plan. (By the way, an unplanned pregnancy is not considered an accident either J. :-) 

•   Hospital Only or Basic Plans. These plans tend to offer good coverage in the hospital but little coverage outside of the hospital. These plans can save you from a hospital bill that might otherwise bankrupt you. However, today hospital stays are getting shorter and more and more healthcare is being done in doctors offices. If keeping your premiums low is important, consider a plan that covers you both in the hospital and in the doctors office that has a high deductible.
•   School Sponsored Clinics And Urgent Care Centers. They cover you well for the little things, but not so well for the big things. There may be no coverage for surgery or hospitalization. In contrast to hospital only plans, these plans my not cover you for a hospital stay or for surgeries.

I Don't Understand My Health Insurance Options

You don't have much if you don't have your health. If you don't have your health insurance in order, life can be a series of waiting for the other shoe to drop as you wait for an injury or illness that may or may not occur. If you need help in getting and understanding the world of health insurance, then read on for some great tips.

To save money on your health insurance plan, do not be fooled by plans with offers that are too good to be true. For instance, some plans may not require any fees for particular everyday preventative care, but do not have the benefits that many other health insurance plans offer.

Use an online calculator to figure out how much a particular insurance plan will cost you. There are many available from different sites that can help you compare different plans. You can figure out what balance you want to strike between premiums and deductibles and also compare the cost of copays and other fees.

The best way to get to know your market niche is to immerse yourself in the niche community. Become a member of online forums that pertain to the market you want to enter. Comment regularly and interact around the forum. Build a reputation for being helpful and inquisitive. You can learn a lot from the other forum members about your niche.

Group health insurance is generally much less expensive than purchasing coverage on your own. If you are self-employed, search around and see if there are any group plans you could fall under. Check with alumni associations, unions, and trade groups to see if they offer group plans under their umbrella.

No one should have to go without health insurance. The advice given to you in this article is an attempt to get everyone the information that they need to have quality and affordable insurance for themselves and their families. Here's to your good health and good health insurance!

Health Insurance - Tips to Help You Choose the Right Policy

Choosing the best health insurance plan involves the following:

•     Finding the health insurance plan with the lowest cost (but only with respect to the other two criteria)
•     Finding the health insurance plan with a network that meets your needs
•     Finding the health insurance plan with coverage that meets your needs

Choosing the right health insurance policy involves finding the lowest price amongst the policies that meet your needs as to network and coverage. Choosing the lowest price is of course very easy. Determining whether the health insurance plan's network of doctors meets your needs is only a little more difficult. Choosing a health insurance policy that covers you well can be complex. Most of this article focuses on this area. I've been a health insurance agent since 1985 and have helped many families find affordable health insurance. You can find out more about me by visiting 1800insuranceCT.com. These are the strategies that I use when helping a family find good medical coverage in my home state of Connecticut. To help find out what health insurance plans are available and approved in your area, I've put together a list of Insurance Departments for each state.

Choosing the Health Insurance Plan with the Right Network

Most companies have websites that will list the doctors and hospitals that participate in their plan. All that I'm aware of will have a printed list that they can mail to you. The right plan will have your doctor on their list or at least doctors who serve your home area. If you travel it is important to find a plan that covers you well in other geographic areas as well.

Choosing the Health Insurance Plan with the best coverage

Health insurance contracts may be the most complex of the insurance policies purchased by the average family. Understanding how your health insurance policy will pay for your medical bills can be difficult. Fortunately most of the brochures and outlines of coverage that you may receive from a health insurance provider will have a similar structure.

They will have sections similar to the following: What is Covered? Health Plan Exclusions and Limitations What is Covered?

This section will detail what medical procedures your health insurance policy will cover. The policy should have a phrase like "reasonable and customary" or "usual, reasonable and customary" or something similar when describing how much they will cover.

Watch out for health insurance policies with:

Dollar amount limits for each procedure

A long list of procedures that the health insurance policy will cover Better health insurance policies will not list dollar amounts for each procedure. They will pay using a formula that is based on what other doctors or medical providers will charge you in the same geographic area. A phrase like "usual and customary" indicates that they use such a formula. The cost of medical care rises so quickly that a dollar amount that seems impressive today may not fully reimburse you even a year from now.

Solid health Insurance policies will not have a long list of procedures that they will cover listed on the policy. The long list seems impressive because the list takes up a lot of space. Look at the statements below. It should be easy to choose between one and two.

    "Our health insurance policy will cover you for everything except for expenses caused by self-inflicted injuries and substance abuse." ("I've been to every state in the union except Alaska.")

    "Our health insurance policy will cover your nose, your ears, your toes, your hands, your right lung, your calf and your knee" ("I've been to New York, Connecticut, Nebraska, Washington DC and Vermont")

Health Plan Exclusions and Limitations This section will tell you what is excluded. Typically elective surgery will not be covered. Also experimental procedures and expenses caused by self-inflicted injuries will not be covered. You should understand each of these exclusions and limitations before you commit to a policy. Most policies will not include maternity insurance, so if you want to get pregnant, make sure that you know how your policy will cover maternity expenses. Unfortunately, maternity insurance is not available in many states except as part of a group insurance plan. To summarize:

* Determine what health insurance plans will cover you in your area

* Determine which health insurance plans offer adequate coverage

*Choose the plans that offers the best value based on price and coverage