Legal question, in reference to medical claims.

Discussion in 'Off Topic [BG]' started by McHack, Aug 31, 2004.

  1. McHack


    Jul 29, 2003
    Central Ohio!

    I've got an issue which I have just been presented with.

    A little over one year ago, my step-son broke his wrist at football practice. So, we rushed him to the ER, & against our better judgement, notified his dad. (guy's a REAL suckwad)

    Well, wife & I weren't married, yet. However, once we were, I included her two kids on MY medical insurance policy, because step-dad withholds the Health Insurance cards from her.

    Well, my wife just called me & the Dr's office who was the specialist in all this, & informed her that the step-dad, came into thier office w/ a photo-copied version of MY insurance card. He's trying to use MY coverage for this debt.

    Isn't this health insurance fraud? What're my options?
  2. Bassic83


    Jul 26, 2004
    Texas, USSA
    It depends. Were you covering the kid at the time of the claim? If so, then it isn't fraud. If you weren't (which I suspect is the case from your wording), it may not be fraud, but it is not correct, and you shouldn't owe a dime. I would get in touch with your state board of insurance or whatever your analog of that is and inform them that he is trying to use YOUR insurance to pay HIS bill...they don't look kindly on that sort of thing. Let them press charges. If he signs your name on anything with your insurance number on it, then you'd have him dead-to-rights, and a lawsuit should be filed straight away. That is not only fraud, but also could be construed as identity theft, which is pretty serious as well.
  3. IvanMike

    IvanMike Player Characters fear me... Staff Member Supporting Member

    Nov 10, 2002
    Middletown CT, USA
    +1 BIG TIME
    hack you know I think people should pay for themselves................................................. :p
  4. nonsqtr

    nonsqtr The emperor has no clothes!

    Aug 29, 2003
    Burbank CA USA
    Where did he get the photocopy? Was it obtained through legal means? If not, you may have a case. If he removed the card from wifey's wallet, for instance, that would be theft, and by extension then, fraud. If on the other hand, wifey gave him the card and told him to use it in case anything ever happened to the kid and you weren't around, then there's probably no case (in most states).
  5. hyperlitem

    hyperlitem Guest

    Jul 25, 2001
    Indianapolis, IN
    kill him.....i going to class
  6. McHack


    Jul 29, 2003
    Central Ohio!
    Well, my step-daughter's braces are being covered by my insurance, & that's where he got the photo copy. The card that was presented to the specialists office is the one for his daughter, & he must've gotten it from the orthodontists office.
  7. HeavyDuty

    HeavyDuty Supporting Curmudgeon Staff Member Gold Supporting Member

    Jun 26, 2000
    Suburban Chicago, IL
    If the date of service was prior to the coverage inception date, there's no coverage. My reading of your post is that your stepson was added after the injury.

    I would advise the insurer that an unauthorized person (the ex) submitted the claim, just so they don't think YOU were trying to play games!
  8. nonsqtr

    nonsqtr The emperor has no clothes!

    Aug 29, 2003
    Burbank CA USA

    The orthodontist's office should have known better. There are strict medical and legal guidelines about who can give out medical information and how much of it they can give out. This might be covered under the new HIPAA laws for example (privacy of medical information). Sounds like you might have a case against the orthodontist. Not entirely sure how dental relates to medical, that might be an interesting legal issue, but as far as I know dentists are covered under HIPAA too.