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    gj4csmom's Avatar
    gj4csmom Posts: 2, Reputation: 1
    New Member
     
    #1

    Aug 18, 2008, 12:23 PM
    Is this Health Insurance Fraud?
    I was terminated from a large company on 4/1/05. They gave me a severance package and were supposed to extend my health insurance benefits for 90 days. During that time, I had to go to the hospital. My former employer was aware that I had developed medical issues and stated that they would keep me on indefinitely. However, that was VERBALLY, not in writing. After the 90 days, I got no notice from that carrier. In the meantime, I got on my spouse's plan.

    This year, I had cancer surgery at the same hospital. My husband's carrier has sent me a notice that they are secondary because my primary insurance carrier paid the hospital. You guessed it! The hospital filed with the same insurance carrier as 2005. So, I called the carrier and they said that I remain active. I explained that I was only supposed to be active for 90 days. The carrier said that they could not do anything to help me. So, I called the benefits department of my former employer. I can't get anywhere with them.

    How far should I go with this? Am I committing fraud? I cannot seem to get anyone to care that someone has been paying for full family coverage for three years!

    There is a part of me that simply wants to let it go because I am afraid that I will get in trouble if I bring it to someone's attention. Also, they were really crappy when they terminated me after 90 days because I "did not fit their corporate culture." So, there was bad blood. However, my boss' boss told me that she would "see me through my medical situation." Unfortunately, she is no longer there.

    What would you do?
    StaticFX's Avatar
    StaticFX Posts: 943, Reputation: 74
    Senior Member
     
    #2

    Aug 18, 2008, 12:32 PM
    Personally, I would look the other way. There is the chance that if you open up this can of worms, the bills will com back to you... not good. Let it lie as is. :) I don't think you can get in trouble... it was not in your knowledge that this was happening.

    Just my 2 cents. Maybe try to straighten it out now... tell the old company you don't need it anymore and are on your husbands.

    Good luck.. just be glad you got it paid for!
    gj4csmom's Avatar
    gj4csmom Posts: 2, Reputation: 1
    New Member
     
    #3

    Aug 18, 2008, 01:12 PM
    Thanks!!

    Quote Originally Posted by StaticFX
    personally, i would look the other way. there is the chance that if you open up this can of worms, the bills will com back to you.... not good. let it lie as is. :) I dont think you can get in trouble... it was not in your knowledge that this was happening.

    just my 2 cents. maybe try to straighten it out now... tell the old company you dont need it anymore and are on your husbands.

    good luck.. just be glad you got it paid for!
    smearcase's Avatar
    smearcase Posts: 2,392, Reputation: 316
    Ultra Member
     
    #4

    Aug 18, 2008, 05:50 PM
    I don't think you have committed fraud but I don't know what the law says.
    I have read about people who were overpaid by bank tellers being charged for fraud or something and that certainly doesn't seem right.
    But if your boss said they would keep you on indefinitely, then I would assume she issued those orders. Maybe they have something in writing from your former boss.
    Can you find your old boss and get her opinion? If a problems develops will she verify her statement about keeping you on indefinitely?
    Another option might be the state insurance commission. They may have precedent from that happening before or might even be a regulation.
    Maybe a lawyer would offer some advice for free or a reasonable fee.
    I think from your posting that you are going to be uncomfortable until something gets resolved. You did not become aware of the continuing insurance until this year and if you do something in writing, within a reasonable time of knowing about I think you have been very reasonable. I would try to talk to the former boss before doing anything else.
    Fr_Chuck's Avatar
    Fr_Chuck Posts: 81,301, Reputation: 7692
    Expert
     
    #5

    Aug 18, 2008, 06:40 PM
    No, you may have two or three policies if you want to. But only one is primary and they pay first, then the next.

    This is not really uncommom.

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