How Effective Are Health Insurance Claims?

by Lyju Kuruvilla on  July 5, 2011 at 4:23 PM Health Insurance News
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Fraud is something that is known to every business that has been established. Just like other businesses have suffered losses because of fraud, insurance businesses have also suffered the same thing. This is because of the fact that they are dealing in millions of dollars, and people are ready to use tactics in order to trick the companies. Regarding insurance in general one can say that there have been several cases of fraud known, and many have even gotten away with it. For those that were caught out in tricking insurance companies, it must be asserted that they were penalized.
 How Effective Are Health Insurance Claims?
How Effective Are Health Insurance Claims?

The risk that insurance companies are at each time they sign a policy with a customer depends on the trustworthiness of the person. As an example of insurance fraud in general, automobiles that were insured and subsequently stolen, had to be paid in full to the customer. This is because of evidence lacking in the company's favor. The customer after paying his premiums had to be insured. However, nowadays, companies have turned a little smarter regarding paying out compensations. They have sought to tactics that help verify cases. If they suspect that a person has pulled a fast one on them they will conduct further investigations. Sometimes this strategy applies to other forms of insurance.

It is likely that an insurance company would double-check or run background checks on a person suspected of committing a fraud with them.

Regarding health insurance, companies may also conduct checks on a person. This is because there have been cases with fraud as well in health insurance. The fraud usually takes place in the form of cheating. For instance, if a customer says that he/she does not consume a particular substance that is hazardous to the health while he/she does just the opposite, it could cause problems. Suppose the same customer develops a condition that he/she wanted protected through the plan, and that condition developed because of consuming the substance that he/she was not supposed to. This means that a fraud has in fact occurred, and the insurance company has every right to withhold payments to the client.

In order to determine whether or not a person has really used a prohibited substance that was responsible for the onset of a condition, medical examinations are conducted. In the actual sense, one cannot really determine whether the prohibited substance was the real cause of the condition or whether it was some other factor. Proof that the prohibited substance was consumed is more than enough for an insurance company to win its case. This is precisely what happens in many cases. Sometimes, customers may not even realize that they have consumed a prohibited substance; they may have consumed it as a component of another mixture, and may not have really known about it. Hence, people really need to be careful when they are under health insurance plans.

In most cases, it is not a problem to get an insurance claim. This is because insurance companies know who they can trust and who they cannot. As far as claims that are made for cancer, insurance companies tend to scrutinize the customer. This is in order to make sure that the cancer has developed in spite of the person adhering to precautionary measures.

Source: Medindia

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