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Ex Wife Still Uses His Union Health Insurance?
Rocky asked:
<BR%20/>Tags: Quick Divorce, Insurance Fraud, Brother, Felony, Plastic Surgery <BR%20/>Hi! My brother and his ex wife got divorced back in 1999. It was a quick divorce and he now has zero ties to her. He pulled his credit report last month and found that she has been using his Union health insurance for plastic surgery as recent as 2006. There are 4 records on his file that he had me call on to get the patient info and they were all from his exwife. Can he sue her for these? Isnt this insurance fraud and a felony?
insurance doesn’t pay for cosmetic surgery…..
That’s fraud!
I believe it is insurance fraud. Your brother should contact the insurer and let them know she is illegally using the insurance.
Actually, it is insurance fraud and she can get into a lot of trouble for this. He should actually report this to the insurance agency and let them know whats been going on. If anything, she may have to go to court and plead guilty to insurance fraud…which can come with jail or paying back all that was paid for her to use the insurance.
And he should report this right away. Because if he knew about it and didnt report it, he can get in trouble as well. Teach her a lesson. She is still trying to mooch off of him somehow.
All the answers are correct. No insurance policy is going to pay for cosmetic surgery and he needs to contact his insurer and provide a copy of the divorce degree. Furthermore, he should have removed her from his policy at the time of the divorce.
She wouldnt have been able to use his insurance if she wasnt on it!!!
He may have forgot to remove her.. and he might be responsibal for some of the charges!
It isn’t insurance fraud if the company failed to cancel coverage, if the ex husband FAILED to notify the company. Also, some insurance companies DO cover cosmetic TYPE surgeries if it is medically necessary
also you have to look at the divorce decree. he may of had to keep insurance available to her for a certain amount of time.
It’s fraud. If he didn’t notify the insurance company it’s his negligence but she willingly and knowingly used his insurance which is against the law
It sounds to me like it’s HIS fault for not taking her off his health insurance. And to those of you who are saying that insurance doesn’t pay for plastic surgery, you’re wrong. There are procedures which can be coded as medically necessary that are covered by insurance. Most of them are reconstructive and life quality issues.
Was she badly burned and needed scar resection? Did she have a deviated septum which affected her breathing? (rhinoplasty = nose job) Did she have questionable spots on her body that needed to be removed and biopsied? All of those procedures can be done by a plastic surgeon.
A boob job, however, is not.
And as far as YOU calling to get the patient information on his ex, unless your brother has given the insurance company express permission to discuss these cases with you (usually in writing or while standing there on the phone), if you misrepresent yourself as your brother, you’re also committing fraud. HIPPA is a federal law and anyone who violates that law is subject to federal imprisonment and heavy fines.
Be careful what kind of information you access and use against his ex-wife as it may come back and bite you in the hiney.
Does the divorce decree allow her to be on his health insurance? He’s got to read the fine print. How can he not know she was on his insurance without paying the premiums? Did he ever contact the health insurance to let them know he was divorced? If it turns out that she is not supposed to be on his health insurance, the insurance company will be the one to sue for fraud and try to get their money back.
Cosmetic/plastic surgery is not usually covered by health insurance unless there was a medical reason for it…such as person having breast cancer, was forced to go through a mastectomy and then plastic surgery to create a breast to replace the missing breast.
It’s not insurance fraud if he didn’t take her off his health insurance. If he’s paying the premiums how could he not know?. She obviously has an insurance card and he needs to get this taken care of with his Union.
He can’t sue her because he has no loss. He needs to inform the insurance company of what he found in his credit report. The investigation and filing of charges, if there was indeed fraud, is up to them. Assuming he took her off the insurance back in 1999, he’s out of the situation. If he failed to notify the insurance company or union to remove her from the plan, then there’s likely nothing to be done about past charges, but they will correct the record going forward.