SCAMS BULLETIN Host Jay White is an inactive attorney in San Mateo County, California

November 18, 2020.

HEALTH INSURANCE FRAUD    

Having personal health insurance can provide a welcome degree of comfort for the future.

But obtaining the right health plan can feel like navigating a maze, with bewildering coverage and cost choices. Most insurance policies contain much “fine print” that is not easily understood. Shady fraudsters count on confusion to sell insurance products and health services that deliver far fewer benefits than promised — or none at all.

These schemes proliferate when health care is in the news and on our minds. The coronavirus pandemic has brought robocalls and phishing emails peddling bogus “corona insurance” supposedly covering COVID-19 treatment.

Fraudsters try to convince you they have a simple solution to the complexity and expense of being covered. They cold-call potential victims or generate leads through websites, using paid advertising to get to the top of search results. They claim to offer “comprehensive” health plans that meet “Obamacare” or “Trumpcare” requirements.

Some crooks wrongly use the names and logos of well-known insurers or even AARP. People who respond are then peppered with misleading promises of full coverage with low premiums, deductibles and copayments. The resulting policies will likely turn out to be, at best, far skimpier than advertised and at worst outright fakes.

Often, victims are tricked into buying medical discount plans, in which they pay a monthly fee for reduced prices on specific services and products from participating health care providers. Some discount programs are legitimate, but as the Federal Trade Commission (FTC) warns, they are not a substitute for health insurance.

Scammers impersonate representatives of the government-run health insurance marketplace. They will tell you they need personal information to verify an application or that they can help you choose the right plan — for a fee. This is an attempt to steal your identity.

Warning Signs

High-pressure sales pitches that push low-cost plans or offer special rates if you sign up right away.

Claims that a plan is licensed under ERISA, the federal Employee Retirement Income Security Act. That is incorrect.  Insurance companies are licensed by the states, not by any federal body.

A plan requires you to join an “association” or “union” to get covered. These may be fake organizations designed to create the illusion that you are buying group health insurance.

Someone contacting you about health coverage claims to be from the government. No government representative will ever try to sell you insurance.

Do’s

Do compare rates. Premiums for comprehensive coverage that are far lower than what you see elsewhere are probably bogus.

Do confirm with your state insurance commissioner that a plan provider is licensed.

Do insist on seeing a statement of benefits or a complete copy of the policy before you sign.

Do learn the difference between medical discount plans and health insurance. The FTC offers guidance. Ask specific questions to make sure you know what you’re getting, http://www.ftc.gov.

Do research an association or union named in an insurance pitch. Look for a U.S. street address and phone number, and for evidence of activity other than selling health insurance.

Do check out an unfamiliar company that says it sells plans through a major insurer such as BlueCross/BlueShield. The affiliation should be confirmed with the big-name insurer.

 Don’ts

Don’t enter personal information on a website in exchange for a price quote. You likely are setting yourself up for identity theft or a barrage of sales calls.

Don’t keep talking to a sales agent who gives vague or evasive answers to coverage questions or tells you the details are “in the brochure.”

Don’t sign up for a plan if the bar or price seems too low — for example, if you are not required to get a physical or provide a medical history. Some scam sites claim you can get insurance by just filling out a form.

Don’t give bank account, credit card or personal information, or make a payment, in exchange for assistance in getting coverage. Help navigating the health insurance marketplace is available free. Go to HealthCare.gov and click “Find Local Help.” Real health insurance marketplace representatives will not ask you for personal or financial data.

More Resources

If you suspect there is a health insurance scam, file a complaint with the Federal Trade Commission www.ftc.gov, or call 877-382-4357. Also, report to your state insurance department.

HealthCare.gov, the official Affordable Care Act website, has information on preventing and reporting suspected Health Insurance Marketplace scams.

You can call the AARP Fraud Watch Network Helpline: 877-908-3360

ATTRIBUTON: AARP