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Has health insurance fraud caused you to lose health insurance?

Do you know that one of the reasons for high health insurance premium is health insurance frauds? That’s right, health insurance frauds cost the insurance companies millions of dollars and to mitigate the loss health carriers pass it to the consumers in the form of increased premium. Health insurance is gradually becoming an item of luxury and frauds have contributed towards it in a great way.

Forms of frauds

Health insurance fraud may evolve around people like- doctors/therapists/hospitals, consumers, agents and at times even the health insurance carrier. However, false/improper billing may be the most common form of health insurance fraud. Also it is illegal to charge more from the insured patients than uninsured ones for the same service rendered. Health fraud can occur in any of the following ways.

• The doctor’s office may charge for services that were not rendered or tests that were not performed.
• May bill twice for the same treatment or can file multiple claims for single treatment performed.
• May charge for unnecessary treatments and tests. Also the treatment process can be stretched in an attempt to collect more from the insurance companies.

Prepare yourself against scams

Awareness and knowledge are the main weapons in the battle against. Actually by practicing few simple steps you can protect both yourself and your family.

• When you are planning to buy health insurance, check with the authenticity of the company. The BBB and the State Insurance Department would give you the idea of the company which has approached you to sell insurance coverage.  Don’t forget to look up for the licensing detail of both the insurance company and the agent.
• If a deal sounds too good, most likely it’s a fraud. Remember that no benefit comes for free. Therefore, if you are offered too many benefits at a very low cost, be weary of it.
• Look for possible signs of fraud. If the sales person is too eager to sell the product, simply tell him that you need more time to think.
• Most of the billing related frauds can be detected by examining the insurance payment statement. Preserve the bills of the services that you have received. It’d help you in comparing the actual charge and claim value.
• If you suspect any fraudulent activity immediately make the respective departments and/or insurance company aware of it.

Let’s the congress battle it out whether or not we should have healthcare for all but for the time being we can educate ourselves against health insurance fraud so that we don’t end up losing what we have.

How HRA’s can help you save in health insurance costs?

Health Reimbursement Arrangement or HRA is a government based program which can help in reducing the constantly rising health insurance costs. HRAs are offered as a part of consumer directed health plans (CDHP) which can help in reducing the cost without compromising on the coverage aspect.

Features of HRA

The following are the features which has made the idea of HRA so popular.

• HRA is an employer funded account which would contain the employer’s contribution towards employees’ health benefits. The charges of healthcare would be paid from this account on qualified medical expenses.
• HRA plans have helped in spreading awareness amongst the consumers and thus have reduces over utilisation of health insurance.
• The amount in a HRA account can be rolled over to next year if the member doesn’t use entire fund available to him. Therefore, the money in the HRA account can grow tax deferred.
• The HRA account is free from state, federal and FICA taxes.
• The health reimbursement arrangement has also improved the quality of healthcare rendered to the members since preventive care, immunization and child care benefits are normally covered on the first dollar basis and are not charged against the employee’s fund.

How does HRA function?

HRAs are associated with high deductible health plans. The employers can save on the premium by raising the deductible level. The saving therefore can be directed to the HRA accounts.

The employer contributes a pre determined amount towards the HRA account on a regular basis which the employee can access upon submitting a reimbursement request. The following two documents should accompany your claim.

• The HRA reimbursement form
• Explanation of benefit form, copies of the receipts of the services rendered.

How to deal with health claim denial?

Procuring an insurance policy doesn’t guarantee that all your claims would be paid. A policy document normally describes the conditions which would be covered and which wouldn’t. Therefore, you should always read the policy paper thoroughly to make yourself aware of the terms and conditions of the insurance company. But, there are times when a claim may get denied wrongfully. And, you may then leave with the option either to accept the cost and pay yourself or fight it back.

Know your rights!!

When it comes to fight a denial, knowledge would be your key. If the insurance company decides to deny a claim they would also issue a claim denial letter citing the clause from the policy. Therefore, it’s important that you know what your policy offers.

Ways to avoid a claim denial

• Review the policy time to time to make sure you have the coverage you want. If there are ambiguities regarding coverage, ask the agent to clarify it for you. You are entitled to proper explanation regarding benefits.
• Make yourself aware of the limitations of the policy. If your policy practices referral system, make sure that you obtain it before seeing a specialist. Also keep yourself updated with availing the services of out-of-network physicians.
• Make sure that your doctor understands the coverage of your policy. Often the doctors have to deal with various insurance companies and therefore it isn’t possible for them to remember each and every policy details.
• Save the documents of the treatment that you have received. It’d help at the later stage of disputing with the insurance company.
• Some policies would have a time limit within which a claim needs to be filed. Confirm that the doctor’s office send the claim to the insurer immediately.

But, what would you do if your claim gets denied?

Inspite of your best efforts your claim may still get denied. What would you do if such a situation arises?

• Call up the insurance company and speak to the customer care representative if you feel that the claim was wrongly denied. Many a times a claim may get denied because of administrative errors and a call to the insurance company can sort the matter out.
• If the problem persists, ask the insurance company to send you customized bills. Check if the list has listed services that were not rendered to you. If such a thing has happened, take-up the issue with the hospital or the doctor’s office.
• Ask for a formal review of the claim when the denial seems legit but you still feel that it should be covered. Most of the states have a time limit within which one is required to request for review.
• When everything else fails your option would be to contact the state insurance department. Every state has definite rules to deal with such situations and most of the times these policies would favour the customers.

Premium waiver a welcoming option for laid-offs

With the economy going south, maintaining coverage and at the same time saving money on the premium has become a concern with the professionals. Therefore they are looking for policies that would react according to their income fluctuation. Premium waiver can be a welcoming relief for people in financial crunch.

What does premium waiver do?

Premium waiver has been a known option with the life insurance policies. Under normal circumstances you would have to discontinue the life policy if can’t afford the premium. But premium waiver allows the insured to continue enjoying the coverage when he/she is receiving disability benefits and can’t afford the large premium payment towards life insurance. However, you need to specifically ask the agent for this rider because it may not come with every life insurance plans.

Guardian’s ProVider Plus with premium waiver option for unemployed

The Guardian Life Insurance Company of America has recently announced a policy called ProVider Plus, which would have the option of premium waiver for a year if you become unemployed.

The ProVider Plus is an individual disability plan which would continue covering the insured even during the period of unemployment, so that you no longer have to put-off the idea of purchasing policy when you are not earning.