Health Plan Scams: How to Dodge, Escape and Fight Back

Posted on Monday, May 13, 2019

Many Americans cannot afford health insurance in the current economy. Even more alarming is the rapidly rising number of fake health plans, seeking to take advantage of desperate people.

The scams' modus operandi is simple: Create a bogus health plan which is enticing and "affordable" enough for the uninsured to take the bait. They use the plan, creating medical bills, and then find out they not only lost money paying premiums on a worthless plan, but they still have to pay the medical bills which they thought would be covered.  

Many scammers have taken advantage of modern technologies in luring their victims, some advertising on television, and using e-mails and faxes. They capitalize on their potential victims' inadequate knowledge, and exploit the widespread confusion on healthcare reform. 

The only way to outsmart these health plan scammers is by becoming equipped with knowledge, understanding – and vigilance. 

How the Plans Work and Signs to Watch for

A full insurance coverage for a very low price? Some things actually are too good to be true, especially when well-practiced scammers use a strong sales pitch and lots of hype. If these initial signs do not raise red flags, maybe the cheap plastic or paper membership cards will. While some "fake" health plans do include minimal discounts or benefits, these prove to be practically useless and never amount anywhere close to the premiums paid by the victims. 

Here are some of the signs everyone should keep in mind to avoid becoming a victim of health plan scams: 

Aggressive sales pitches via telemarketers, e-mails and faxes
Messages and advertisements which display only toll-free numbers and not company names
Claims stating the plan is compliant with health reform and is now required
Incredibly low premiums and low deductibles
Vague answers to questions
Enrollment process which is as simple as filling out a form
Pushing for banking or financial information too early in the process
Vague and questionable websites
Aspiring members are required to join associations or unions
Plans offered in states where federal licenses are not required
Slow correspondence or suspicious delays with payments

The Effects of Scams

Apart from unwillingly funding the crimes of scammers, victims are hurt by fake health plans in several ways. One is financially, as paying for medical bills after losing money on fake policies multiplies the victim's losses. Since the main reason why victims often fall into these traps is their lack of financial capability, the problems tend to worsen as savings run dry and debts accumulate. The worst effect of these scams, however, is when victims or their beneficiaries endanger their health without any insurance or savings to rely on.  

Fighting Back Against Fraudsters

The best way to fight health plan scammers is by protecting oneself. To prevent scammers from victimizing more people, scrutinize every document and every word from an agent you feel is suspicious. Never give out critical financial information before signing a contract. Perform a thorough background check on the insurance provider. This includes seeking information from third-party sites and reviews from existing clients. Go a step further and verify whether the products or services being offered are licensed with the state.

Discussing concerns with a trusted agent is also recommended, as they have the background and networks to help verify legitimate health plan providers.

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Disclaimer: The information contained in Dulin, Ward & DeWald’s blog is provided for general educational purposes only and should not be construed as financial or legal advice on any subject matter. Before taking any action based on this information, we strongly encourage you to consult competent legal, accounting or other professional advice about your specific situation. Questions on blog posts may be submitted to your DWD representative.

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