Saturday, October 1, 2011

self employed health insurance

Everyone knows that the health insurance industry is constantly increasing monthly premiums, and many find it unjust to you as a consumer. However, the insurance industry had an 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 a year industry, the issue would not be taken lightly. Each health insurance policyholder should understand what health insurance fraud and its consequences. By doing this, you are better able to recognize and fight fraud.


Health insurance fraud is generally defined as willful cheating, wrong, or concealing information to receive benefits from the insurance company. In essence this means that you claim that you paid for certain medical procedures or expenses out of pocket, you do not actually received, and you are filing claims with the insurance company to receive compensation. Another example of member fraud is to pre-existing conditions to hide or alter medical documents so that non-policyholders or ineligible members receive medical benefits under your policy. Maybe your sister has no insurance and need medical attention. Having her use your name and policy to cover the costs is health insurance fraud. While you might think this is a small problem compared to your sister in treatment, it is actually very serious to your health care and industry, and will result in fines and possible imprisonment if caught.


Not only policyholders commit fraud, but providers (doctors, hospitals, etc.) as well. Because doctors and hospitals paid by the insurance company for the services they provide to you, they also receive reimbursement of the insurance company. When providers commit fraud, they may be billing the insurance company at higher rates for its services, or they may bill you for services you never received. In these cases, you will probably be asked to cooperate in the investigation of the insurance company.


Another type of health insurance fraud that has recently developed, focuses on the policyholder more than the insurance company. Program  s have developed where fake insurance companies or agents sign unsuspecting customers for coverage at surprisingly low premiums. They often act much like a regular insurance company for the first few months, paying for smaller medical claims, such as doctors visits. But once you have a more serious medical condition requiring treatment, the insurance company will need to disappear - along with the money you have to pay the premiums.


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