6 ways to elude health insurance scams

By saurabhisarmah | March 30, 2015

Credit Card Fraud

Are you over 60? Or know someone over 60? Chances are there is a savvy scammer lurking in the shadows, plotting to make off with your or your loved ones’ hard-earned money. And steal your dentures while at it.

Health insurance scams involving senior citizens are becoming more prominent across the country. Senior citizens are commonly targeted by tricksters who assume their quarry has a significant amount of savings and can be easily swindled off it.

Often these scams remain unreported and can be totally devastating for the victims. Seniors are particularly affected because in addition to being drained of their savings, they are left without adequate health coverage when they most need it.

Health insurance is not easy to avail as one ages and considering the lack of steady income in case of retirees, availing quality and affordable healthcare is very important.

Why are senior citizens targeted?

Seniors are soft targets as they are presumed, often wrongly, to be slow on the draw when it comes to new products.

They are also quicker to trust and often have their finances handled by younger family members or close advisors, all of whom do not always hold their best interests at heart.

Many often people buy health insurance considering its importance during their old age but without understanding the ensuing terms and conditions.

How do health insurance scams work?

Tricksters normally send fake representatives to meet with seniors to convince them about the benefits of health insurance policies or to provide fake medical services. In the process, they collect personal information of seniors in order to access their savings easily.

Also, many scams involve telemarketing and emails offering false health insurance or medical facilities which require seniors to reveal their medical or bank account details.

In some cases, mis-selling of genuine policies leads to a senior citizen availing the wrong type of plan or one that he or she cannot really afford. Many health insurance policies exclude coverage of pre-existing diseases or require high premium payments if policyholders cross a certain age.

Sometimes, it is seen that patients undertaking treatment at hospitals are made to sign for more expensive procedures that are generally not covered under their existing insurance policies. In many other cases, manipulation of documents by hospitals or TPAs (third party administrators) occur, affecting claims.

It’s not only wealthy seniors who are targeted; low-income seniors also fall victim to health insurance scams. Sadly, it’s not always strangers who commit such crimes against seniors but known family members, neighbors and friends. There are instances of some unscrupulous health insurance agents cheating senior citizens.

Tips to avoid health insurance scams

Don’t respond to unknown e-mails or phone calls: Don’t ever reveal your personal information and bank details to any individual who doesn’t genuinely identify as insurance agents or health care representatives. Also, don’t respond to any emails coming from unknown addresses asking for your medical and personal information. Safeguard your medical identity from the strangers.

Provide your medical insurance details only to those who have provided you with medical services and whose credentials you are certain of. Remember, genuine financial institutions do not solicit personal information via phone or email.

Beware “free” services: Question ‘free’ services offered by various healthcare organizations. There’s often a flipside when someone offers something for free. You may end up spending more while trying to avail a free service. Remember, usually there are no free lunches.

Evaluate your Medicare summary carefully: Always check your Medicare “summary notice” sent to your home and verify the accuracy of information provided to you. The summary contains a record of the number of doctor visits, hospital stays, ICU charges, medical bills etc.

It may happen that you were charged for services that were never provided to you by your healthcare provider or you were charged for unrequired procedures/services. If you find such anomalies in the summary notice, you should immediately intimate your healthcare provider.

Also, if you can, enlist the help of health insurance experts to help understand your Medicare summary.

Ignore telephonic prescriptions: Do not accept false medical prescriptions or coupons that promise to offer you discounted rates on medicines. You may end up spending more than you think. False drug prescriptions are proffered commonly on the internet or via telephone. Senior citizens are often lured by attractive pricing on particular medications and fall prey to remote fraudsters.

Know your policy before buying it: Try to understand the terms and conditions of the health insurance policy you are planning to buy. A good, genuine policy will provide all the required information in black and white, which you can verify before making a purchase.

Inform your local authorities: Report suspicious or known fraudulent activity to the police or contact your insurance or healthcare provider immediately. This will help protect yourself from fraud. You need to be proactive in identifying suspicious assertions and surrender those policies that carry a high possibility of being fake.

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