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Gaming the insurance system
Old 05-09-2007, 11:37 PM   #1
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Gaming the insurance system

Ok, not that I would do it but.... My MegaCorp insurance sent me a notice that they would not coordinate with other insurance companies, and my wifes insurance said the same thing. Here's the question? If I'm paying the rates for family for both plans, can I turn the cost for a procedure in to both insurance companies and collect from both of them based on their discounted rates. In other words, use the primary insurance for the procudure and then on my own, send in the bill to the second insurance and get paid directly to myself for the amount of money that the inusrance company would pay, but sent to me. This may or may not result in my receiving more from the insurance companies then the total actual cost of the procedure, if I'm lucky. Since I'm paying, or at least my employer is, and by extension, I am, as it is one of my benefits, it would seem that this should be fair. What is the legality of this?
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Re: Gaming the insurance system
Old 05-10-2007, 12:21 AM   #2
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Re: Gaming the insurance system

In order to have the second insurance company reimburse you directly, you'll need to submit not only a bill, but an invoice clearly showing a zero balance. Generally, the paid invoice will show the portions paid by you (co-pay, deductible, etc.) and the portion paid by insurance. Thus, the second company will be able to see what the first company paid.
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Re: Gaming the insurance system
Old 05-10-2007, 05:59 AM   #3
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Re: Gaming the insurance system

Quote:
Originally Posted by whitestick
Ok, not that I would do it but.... My MegaCorp insurance sent me a notice that they would not coordinate with other insurance companies, and my wifes insurance said the same thing. Here's the question? If I'm paying the rates for family for both plans, can I turn the cost for a procedure in to both insurance companies and collect from both of them based on their discounted rates. In other words, use the primary insurance for the procudure and then on my own, send in the bill to the second insurance and get paid directly to myself for the amount of money that the inusrance company would pay, but sent to me. This may or may not result in my receiving more from the insurance companies then the total actual cost of the procedure, if I'm lucky. Since I'm paying, or at least my employer is, and by extension, I am, as it is one of my benefits, it would seem that this should be fair. What is the legality of this?
I am pretty sure its called "insurance fraud".
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Re: Gaming the insurance system
Old 05-10-2007, 06:59 AM   #4
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Re: Gaming the insurance system

Quote:
Originally Posted by whitestick
Ok, not that I would do it but.... My MegaCorp insurance sent me a notice that they would not coordinate with other insurance companies, and my wifes insurance said the same thing. Here's the question? If I'm paying the rates for family for both plans, can I turn the cost for a procedure in to both insurance companies and collect from both of them based on their discounted rates. In other words, use the primary insurance for the procudure and then on my own, send in the bill to the second insurance and get paid directly to myself for the amount of money that the inusrance company would pay, but sent to me. This may or may not result in my receiving more from the insurance companies then the total actual cost of the procedure, if I'm lucky. Since I'm paying, or at least my employer is, and by extension, I am, as it is one of my benefits, it would seem that this should be fair. What is the legality of this?
Only question is whether it's a misdemeanor or a felony.
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Re: Gaming the insurance system
Old 05-10-2007, 07:27 AM   #5
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Re: Gaming the insurance system

Quote:
Originally Posted by Rich_in_Tampa
Only question is whether it's a misdemeanor or a felony.
Depends on the amount.

If you have a good graphics program, you can print up your own invoices.

The best part is, you get free health care in prison.
That's right, free lodging, free health care, sounds like a ER plan if I ever
heard one
TJ
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Re: Gaming the insurance system
Old 05-10-2007, 01:12 PM   #6
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Re: Gaming the insurance system

Although it was MEDICARE "Fraud" I think the concept is the same i.e., the Feds just arrested something like 38 folks down in south Florida for it.
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Re: Gaming the insurance system
Old 05-10-2007, 06:53 PM   #7
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Re: Gaming the insurance system

Let me know how the food is in prision. If it is good your plan may be a good ER plan. :
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Re: Gaming the insurance system
Old 05-11-2007, 09:46 AM   #8
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Re: Gaming the insurance system

Quote:
Originally Posted by teejayevans
The best part is, you get free health care in prison.
That's right, free lodging, free health care, sounds like a ER plan if I ever
heard one
TJ
I hear its pretty easy toget a date there, too...
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Re: Gaming the insurance system
Old 05-13-2007, 09:04 AM   #9
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Re: Gaming the insurance system

It's very unusual for a group policy not to coordinate benefits with another group policy...In some states group policies are not permitted to coordinate against Individual health policies. When this is the case the Individual policy typically states that you are only eligible to obtain and continue coverage if you do not have coverage under a group policy.

Be sure to read the fine print...I have seen self-funded plans (where the employer not the insurance company pays the claims costs) that deny eligibility for a spouse or children who are eligible under another employer's plan..in effect they don't coordinate because you lose eligibility to participate. Tracy
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