Over the years, I’ve heard people–among them insurance agents–wink and say, “If someone needs to go to the doctor for something worrisome, embarrassing or potentially compromising, they shouldn’t go to their general practitioners. Instead, they should go to another physician, pay cash, and use an assumed (false) identity.”
Even in the era of HIPAA, their argument is this: medical records are hardly confidential, considering that one might be asked to grant access to medical/mental health records in cases of clearances, lawsuits, and sundry insurance matters.
All this said, someone seems wrong about this behavior, and possibly illegal. Providing that one is merely trying to keep private matters private–and not commit fraud against an insurance company, such as if one were applying for life insurance and wanted to hide some condition–is the act of using a bogus name illegal?
(Note to mods: My question asks whether certain actions are lawful and is not meant as a solicitation to possibly illegal behavior.)
IANAL, but as far as I understand under the common law you can use whatever name you want (as well as use several) for any purpose as long as it’s not intended to defraud or scam. However, the mere fact of HAVING an insurance policy might make such behavior fraudulent, or at least violate your contract with the insurance company, depending on where you are.
I don’t quite see how, if one is paying cash for medical services, one is defrauding the insurance company by using a false name. There is AFAIK no legal requirement that claims for medical expenses be submitted to one’s insurance company. If an insured chooses not to utilize the coverage s/he’s paying for, it’s no business of the insurer.
Now if the were getting the treatment under an assumed name with no intention of paying, that would be fraud and/or theft, but the victim would be the provider, not the insurance company.
Similarly, if one failed to disclose past treatment when applying for insurance to avoid exclusions of coverage and/or increased premiums, that would constitute attempted fraud of the insurance company. I forget exactly what remedies were available to the insurance companies I worked for.
Why am I not surprised that an insurance agent would say something like that?
You know what? A big EFF THAT. Illegal or no, if I’m paying through the nose for health insurance (and I am), my GP and my HMO can know all they want to about the turkey baster top stuck in my arse. I can’t imagine that this scenario would be useful to anyone except the insurance agency who suddenly doesn’t need to pay out.
Well the way I see it is that the insurance company uses the medical claims you submit to recalculate your premiums. If you hide a chronic and potentially expensive (in the future) condition from your insurance company by paying cash until you can no longer afford it, it may be considered breach of contract or fraud. Again, IANAL, so these are just WAGs.
The question is: Do group policies factor in the medical history of each and every employee? I thought most policies do not count pre-existing conditions, nor do I think they recalculate premiums based on said conditions.
Good question about group policies. Say you’re employed and want to be checked for Alzheimer’s or arthritis or AIDS, and you feel your employer is frequently unethical and would be happy to unethically pick you out for the next layoff once given this information, and the employer is corporately connected with the insurance carrier, and you want to prevent any possibility of this, can you properly do this?
OTOH, very often, concealment and lies generally set you up for difficulties in the future. But this is just failure to volunteer information rather than lying. So…?
