Health Insurance Basics

Avoiding Medical Insurance Fraud


May 22, 2015

Have you ever been a victim of medical insurance fraud? As a health insurance kenya policyholder, you need to be cautious as you manage your cover because you may end up as a victim of insurance fraud. Cases of insurance fraud are on an increase in Kenya especially in the general insurance segment. Industry Statistics indicate that up to 40% of all claims made on policies are fraudulent. As a policy holder, there are a number of things you can do to reduce your chances of getting entangled in medical insurance fraud. Fraud usually happens when someone attempts to extort your insurer based on claims that services for which you are insured were offered. Here are some tips from insureafrika.

1. Ask questions

When you visit a health institution approved by your insurer, be sure to ask questions relating to the diagnosis and prescriptions offered. If you have any suspicions on what you may be suffering from, discuss with your doctor and make sure that the course of action proposed makes sense to you. Ask about the costs of medicines prescribed and ask about whether there are alternatives. Spending as little as possible each time you visit a hospital will ensure that you have some money left on your cover at all times. If you exhaust your cover over unnecessary courses of treatment, you may find yourself having to pay your bills out of pocket. If you develop the habit of asking questions, it will be less likely that you will be billed for services not rendered, hence you will not lose your money to a fraudulent process.

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2. Always keep your card safely

When someone else presents your card at a medical facility and accesses services, you have been impersonated. This situation may arise when someone who you know asks to use your card to access services with your knowledge. On the other hand, a third party, unknown to you may also impersonate you if he gets access to your card. The only remedy for impersonation is storing your cards safely away from any risk of theft. It is advisable to carry the card with you at all times to eliminate this risk and to ensure that you can access medical services quickly should an emergency arise.

3. Keep track of your bills

Keep track of your bills during your hospitalization, especially if you are in long term or intensive care. Keeping an eye on your bills empowers you to make good choices and to develop contingency plans as needed. It is also less likely that a hospital will overcharge you when it is aware of your efforts to keep tab of costs.

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4. Compare prices from different hospital

The final tip to keep fraud at bay is to keep an eye open and an ear out to compare quotes. Why pay more than necessary for an insurance cover if you can get the cover competitively. While this doesn’t necessarily count as fraud, it nonetheless keeps your money where you want it-in your pocket. 

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