Cheating on the Insurance Scheme …
by afaal on Jun.08, 2009, under Health Insurance
In the recent past, many employers are paying for medical insurance of their employees. I have to say that most of major companies have now done this for their employees or are on the verge of doing it. It is of course to the benefit of those people who are enrolled. But unfortunately some people try to take undue advantage of these packages. I have come across few incidences where people have tried to cheat on their schemes.
- Claiming a refund - Some people come to the hospital and take an appointment to see the doctor with their insurance card. Once they get the token, they stay in the queue for a while and claim that they are feeling better and ask for a cash refund of their payment. In this instance they are trying to squeeze some money out of the hospital for their own use. Unfortunately, the hospital will not be in a situation to do that. We have a contract with the Insurance Company and any cancelled appointments will not be charged to the insurer. When we try to explain the situation, these people accuse the hospital saying that we actually will charge for that even if the service is not taken, i.e. they accuse us of stealing. But who is here trying to steal I wonder. Also as the beneficiary of the scheme, the person will know what has been charged also.
- Getting an appointment with someone else’s insurance card - This is a strange situation. Why would someone lend his insurance card to someone else? But people do that and we again will not be in a position do grant an appointment for such presentations. All counter staff will check their photo identifications before an appointment memo is issued. Again our staff face a bashing for this and all sorts of accusations will be thrown at them. I wonder why people try to abuse anything that is good. After all this is medical care and any mishap has consequences that are a question of life and death, be it just a simple outpatient consultation. For those who lend their cards to others, I urge that this practice be stopped. We will not serve them and we will have to inform the authorities about it. For those insurers, I guess people like this should be scrapped off their insurance, at least for a while as a penalty.
- Getting a self-appointment and someone else turning up to see the doctor - This is the worst cheat of all. This is where the control of initial screening is done and the doctor has to just treat the patient. The consequences are extremely high. Just a simple example, what if the person who comes to see the doctor says that he or she doesn’t have an allergy to any medicine. But in reality the actual person who owns the card does have an allergy. When the real person comes to a consultation, the doctor looking at former records could prescribe a medication that is allergic to him. Who is to blame here? Doctor? Patient? Again the hospital will be put is a difficult situation if some adverse event like this occurs.
Understanding such attempts by people, we are now improving our policies on patient identification. But it does not really help unless people are truthful about themselves. Wonder what bright ideas people come up with next!
After all, who are they trying to cheat? Themselves!
October 1st, 2009 on 8:35 pm
great post and very informative, when they get insurance as additional service benefit wonder why they misuse it. great