Hypothetically Speaking

[asher]

Now I know why people have such low opinion of insurance agents.
It's because of people like you.

 

[Newby]

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Uh, I wasn't asking a question about "medical insurance." Obamacare will not affect supplemental disability insurance. You guys on here are really ignorant. I'm doubly disappointed.

Oh, I missed that.

Yes, tell your sister she is a brilliant mastermind and this is a very clever scam. There is no way any insurance company could ever see through her evil plan of obvious insurance fraud.

 

[Accelerated]

My sis and I are having a debate. I'm sure I'm right here's the question..

Hypothetically, let's pretend someone (her) has had individually purchased medical insurance and while covered was diagnosed with a health condition. This condition required her to take meds all of which she side stepped her insurance company and paid for them herself.
Now, she's going to switch to a new provider and doctor. She is also applying for supplemental disability insurance through a separate company. This company has a one year waiting period for preexisting conditions but she's not going to disclose her preexisting condition to the supplemental insurance company because in her words, "how will they find out."
Well, how would they find out? I mean she kinda makes sense because she'll have a new doctor to go with her new insurance and since she paid for her prescription meds herself, it's not going to be in the prescription reporting companies database should they run a prescription report on her.

She says yes. Lol I know, I know!

Actually you are wrong.. Insurance companies use third party companies such as Argus to process prescriptions for their customers. They are called "Pharmacy Benefit Managers" and they supply prescription reporting companies like "Intelliscript" with prescription info on Insurance company members. That information is electronically supplied to a member company for a fee and is use to weed out fraud.
You, are the liar and should really have the facts before spewing off at the mouth.
By the way, no APS will be required since it's guarantee issue. Dick.

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Uh, I wasn't asking a question about "medical insurance." Obamacare will not affect supplemental disability insurance. You guys on here are really ignorant. I'm doubly disappointed.

I became upset when debenefits365 didn't tell the truth. You guys on here are quick to judge because my sister wants to lie but yet, debenefits365 lied. That's the pot calling the kettle black and a lie is a lie.
But my moral compass, regardless of which way it points is not your concern.

Don't see where he lied, but I do see you using being called out for the wannabe crook you are as justification for perpetuating your own dishonesty. If you do not wish to be judged on an insurance forum, my advice would be: "Don't post about your intent to defraud the insurance industry".

It's called "Insurance Fraud" and it's a felony. Hopefully, if your "hypothetical scenario" (sounds more to me like you are just trying to figure out if you or your hypothetical sister can get away with it) unfolds, all parties associated with the fraud go to jail and have to refund any monies spent by the insurance carrier. I really hope that this forum provides evidence in the form of IP addresses and your own words, which I have quoted for the sake of posterity. My understanding is that you receive excellent medical treatment while incarcerated, so maybe it will all work out for you.

 

[jdeasy]

365 was mistaken. That's different than what you are proposing.

Where 365 is just misinformed you are wanting to know if lying is OK.

Get "upset" all you want but your supporting this crap from your sister is just as bad as her actions.

I became upset when debenefits365 didn't tell the truth. You guys on here are quick to judge because my sister wants to lie but yet, debenefits365 lied. That's the pot calling the kettle black and a lie is a lie.
But my moral compass, regardless of which way it points is not your concern.

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Thank you anonymous1.

 

[benefits365]

365 was mistaken. That's different than what you are proposing. Where 365 is just misinformed you are wanting to know if lying is OK. Get "upset" all you want but your supporting this crap from your sister is just as bad as her actions.

I was always told that APS is used on DI contracts. I will concede that that was 10 years ago, and I don't do life insurance. In any area where I spoke out of turn, I do apologize. And I stand by my statement: you are not smarter than a multi million dollar insurance carrier. I do not think its a good idea. Also, I AM a dick. You caught me there.
Hypothetically speaking, of course.

 

[scagnt83]

I became upset when debenefits365 didn't tell the truth. You guys on here are quick to judge because my sister wants to lie but yet, debenefits365 lied. .

365 was mistaken at worse. A lie is intentional with the intent to deceive.
365 was not trying to intentionally mislead you. However, your sister IS trying to intentionally deceive the insurance company. Which is very different than unintentionally being mistaken about something.

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Actually you are wrong.. Insurance companies use third party companies such as Argus to process prescriptions for their customers. They are called "Pharmacy Benefit Managers" and they supply prescription reporting companies like "Intelliscript" with prescription info on Insurance company members. That information is electronically supplied to a member company for a fee and is use to weed out fraud.
You, are the liar and should really have the facts before spewing off at the mouth.
By the way, no APS will be required since it's guarantee issue. Dick.
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PBMs work with more than just insurance companies. And intelliscript gets its info from sources other than just PBMs (although they are the main source).

According to intelliscript, they use data from PBMs, data clearinghouses, & retail pharmacy chains.

Also according to intelliscript, PBMs work with not just insurance companies but retail pharmacies too. PBMs actually act as prescription suppliers for many retail pharmacies.

So according to Intelliscript, if your sister used a retail pharmacy there is a good chance her info is held by a PBM somewhere.



Also, if she were to become disabled they will conduct an audit of the claim. (standard procedure)
This usually involves a review of multiple years of medical records.

Just because you change doctors does not mean they cant request records from an old one. They do it everyday. Often they have a set number of years they request (usually around the last 5 years).

So, this will bring her to the point of having to lie again and say that she had no prior doctor.
But, if she has any rx info out there from that old doc they will see that and then ask for that doctors records by name.

Also, many doctors ask a new patient who the old doctor was. Often they list this in the patients medical records.

Also, if she has ever previously applied for insurance while seeing the old doctor, it is very likely that she is in the MIB (Medical Information Bureau) database. This is a database of underwriting info that insurers share and use.


Long story short, if she goes on claim due to a condition she lied about, all she will get is a refund of premiums. Because they will find out.

 

[smokin goose]

My sis and I are having a debate. I'm sure I'm right here's the question..

Hypothetically, let's pretend someone (her) has had individually purchased medical insurance and while covered was diagnosed with a health condition. This condition required her to take meds all of which she side stepped her insurance company and paid for them herself.
Now, she's going to switch to a new provider and doctor. She is also applying for supplemental disability insurance through a separate company. This company has a one year waiting period for preexisting conditions but she's not going to disclose her preexisting condition to the supplemental insurance company because in her words, "how will they find out."
Well, how would they find out? I mean she kinda makes sense because she'll have a new doctor to go with her new insurance and since she paid for her prescription meds herself, it's not going to be in the prescription reporting companies database should they run a prescription report on her.

You're a moron .......................

 

[lorrieduke]

The answer to your question is called an APS.

That stands for "attending physician statement".
I
The insurance company may order one of these prior to issuing the policy.
Or, they may not. And if she ever files a claim, they will deny the claim, as she withheld "material information".

They can and will find out if they wanna. Lying is probably the worst thing you can do. Not because its dishonest, although that is bad. But because the insurance company now gets a free ride on you. If you never file a claim: great! They just cash your check. If you ever need the insurance, they'll bail in you because you lied.

Do. Not. Do. It. You will not win. Multi million dollar insurance companies don't lose because you thought of something they haven't.

And, as if that isn't enough: prescription drug checks are NOT based on whether you use insurance or not. They use name, dob, ss#, an other identifying characteristics. The fact that you didn't use insurance to pay does NOT circumvent the system.

And finally, doubly disappointed that someone thought they could "game" the system with such a basic scam. Really?!? An insurance company never thought of this?!?! C'mon!

I'm doubly disappointed that you are telling untruths regarding how prescription drug reports are generated. Your giving misinformation. Do you do the same to your clients as well? Why would my question anger you? It's not directed at you personally. Anyways, you guys are vulchers and remind me of a used car salesman.

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Now I know why people have such low opinion of insurance agents.
It's because of people like you.

Your in your own little world.. I'm out here with the rest of the world. I'm in the bigger picture bud.

 

[VolAgent]

I'm doubly disappointed that you are telling untruths regarding how prescription drug reports are generated. Your giving misinformation. Do you do the same to your clients as well? Why would my question anger you? It's not directed at you personally. Anyways, you guys are vulchers and remind me of a used car salesman.

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Your in your own little world.. I'm out here with the rest of the world. I'm in the bigger picture bud.

You are asking how you can commit fraud, and then want to give lectures on ethics? If you think that is the real world, you are deluding yourself.

 

[WinoBlues]

I'm doubly disappointed that you are telling untruths regarding how prescription drug reports are generated. Your giving misinformation. Do you do the same to your clients as well? Why would my question anger you? It's not directed at you personally. Anyways, you guys are vulchers and remind me of a used car salesman.

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Your in your own little world.. I'm out here with the rest of the world. I'm in the bigger picture bud.

How so?

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