married children covered under parents insurance

What is the name of your state?tx

A young woman with whom I am acquainted is 7 months pregnant with twins. She called her sister and myself yesterday because her and her husband went to the hospital to preregister for delivery yesterday. She filled out all the paperwork as married and presented her insurance cards. The hospital was given a call in code or something, because the registrar had to call the insurance company before they could go any further. Once in contact with the insurance company they verified the information the hospital had been given versus the information the insurance company had. The big snafu was in that the young woman's mother had enrolled her daughter on the mother's employers insurance plan as a dependent without informing the insurance company that her daughter had recently married(prior to be enrolled on the plan).

Needless to say the insurance company informed the hospital that as the young woman was married and of legal age and not a student that she was no longer eligible for coverage and that the insurance would not be paying any further claims on the young woman's behalf.

Now I am in no way defending her because both myself and her sister told her that sooner or later the insurance company would find out that she was married and drop her from the insurance.

The question I have is, is this considered fraud? What recourse does the insurance company have to recover monies already paid on behalf of this girl to her doctor? Is the mother or the young lady responsible for paying the doctor back? Does the insurance company have a claim against the mother for knowingly placing her daughter on her insurance even though she knew her daughter was married and not eligilbe to be covered?

I appreciate any and all responses!

Thanks.

[Beth3]

The question I have is, is this considered fraud? You bet. The mother knowingly listed her ineligible daughter on her employer's insurance plan and the daughter went along with it and received benefits to which she wasn't entitled. It's theft.

What recourse does the insurance company have to recover monies already paid on behalf of this girl to her doctor? They can contact the providers directly for repayment and/or sue the mother and the daughter for repayment. They can also file criminal charges against the mother and daughter.

Is the mother or the young lady responsible for paying the doctor back? Either the doctor or the insurance company, depending on how the insurer elects to proceed.

Does the insurance company have a claim against the mother for knowingly placing her daughter on her insurance even though she knew her daughter was married and not eligilbe to be covered? Absolutely. And so does the mother's employer. At a minimum, she's almost certainly going to be fired and it's quite possible she's going to be prosecuted.

That's what I thought, but I wanted to be sure.

I appreciate the information!!

Thanks!