By providing group benefits coverage, employers are investing in the health of employees and their families. Unfortunately, some people may try to abuse or even defraud your plan. This can lead to increased premiums or result in reduced or lost benefits coverage.
Together, advisors, plan members, employers and insurers share in the responsibility of protecting health benefits plans from fraud and abuse.
Here are some tips to help you recognize, report and reject health benefits fraud.
- Check your explanation of benefits statement (EOB) to be sure it reflects what was submitted. It should match the receipts and the products or services you received.
- Never sign blank claim forms. This is your sign off on what is being submitted. Only sign the form once the claiming details have been entered and entered correctly.
- Look at and validate your receipt. Make sure the dates, products/services, charged amounts, and practitioner reflect what you received.
- Understand your health and dental benefit coverage. If there is something you do not understand, or if there is something that is not clear, call the Customer Service Center and speak with a representative about your concerns.
- Asking questions is OK and encouraged! Never hesitate to ask your service provider or practitioner for details relating to the products or services you are receiving.
- Keep copies of your receipts and estimates. They could be requested during routine audits, investigations or claims reviews.
- Protect your personal information. Don’t share your policy or certificate information unless you’re watching a trusted provider submit a claim on your behalf. Do not lend your benefits card or number, and do not allow anyone else access to your benefits information (member website, mobile site etc.).
- Call or email Equitable Life if you suspect fraud or abuse. This could include offers from providers to waive your annual deductible, co-pay the amount not covered under your plan, or provide incentives.
Be as detailed as you can and provide clear information about the provider or practitioner’s name, address, phone number, location and services.
Benefits fraud affects everyone, and it’s our shared responsibility to report it when we see it. If you suspect that a co-worker or health or dental service provider is committing benefits fraud, you can report it to Equitable Life’s Fraud Investigations and Risk Management team by email at: email@example.com or through our tip line at: 1.800.265.8899. You can also report it anonymously to the broader insurance industry.