5 Tips to Avoid Health Insurance Scams

As Open Enrollment ramps up through January, consumers are certain to be inundated with all sorts of marketing about health insurance plans that claim to cost less and cover more. However, it is important – especially in this age where scam artists are getting harder to detect – that you take precautions to avoid health insurance scams. Scams can cost you money, time, and peace of mind, so it’s important that you stay aware of some of the key signs of being swindled. Here are five tips that can help you avoid falling victim to health insurance scams.

1. Health insurance scams usually start with unsolicited contact

It’s happened to all of us, but just like any other scam, criminals using health insurance policies or renewals will start by making contact with you out of the blue. Often, they’ll claim to be from a health insurance company, or even a government agency. Preying on your emotions, they will suggest you need to update some sort of information, or pay a fee, or sign up for a new plan.

If you receive an unsolicited call or email about health insurance, do not give out any personal information (see Tip #3). Hang up the phone or delete the email. If you are unsure whether the call or email is legitimate, contact your health insurance agent or insurance company directly.

2. Research plans to avoid health insurance scams

Shopping for health insurance is just like shopping for any other important service in your life. It’s best not to take the first option, and it’s always smart to do research when looking for the best health insurance plans. Compare plans from different companies and read reviews from other customers.

Beware of plans that seem too good to be true. If a plan is offering very low premiums or comprehensive coverage at a fraction of the cost of other plans, it is likely a scam. You can also check with your state insurance department to make sure the company is licensed and accredited.

3. Protect your personal information

Along with all other personal information like social security numbers, date of birth, driver’s license number and credit card numbers, treat your health insurance card like it is just as important. Like identity theft, there is also something called “medical identity theft.” Do not give it out to anyone unless you are sure they need it. If you are uncertain about anything, ask a friend or loved one for advice. Be careful about where you display your card and keep it in a safe place when you are not using it.

You should also be careful about what information you share online and with other people. Only give out your personal information to trusted sources.

4. Review your explanation of benefits (EOB) statements

An EOB is a statement from your health insurance company that explains the benefits you received for a particular medical service. It is important to review your EOB statements carefully to make sure that the services you received are covered and that the charges are correct.

If you see anything on your EOB statement that you do not understand, contact your health insurance company.

5. Report any suspected scams

If you think you may have been the victim of a health insurance scam, report it to your health insurance company and to the National Health Care Fraud Hotline at 1-800-HHS-TIPS (1-800-447-8477).

You can also report scams to your state insurance department and to the Federal Trade Commission (FTC).

Here are two additional tips to help you avoid health insurance scams:

  • No Pressure: Be suspicious of high-pressure sales tactics. Legitimate health insurance companies will not pressure you to sign up for a plan. If a salesperson is trying to rush you into a decision, it’s a red flag.
  • No Discounts: Beware of promises of free or discounted services. Scammers often promise free or discounted services, such as medical screenings or genetic testing, to get people to enroll in their plans. These services may not be covered by your plan, and you may end up paying for them out of pocket.
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