Multiple Insurances that do not Coordinate Benefits

[regale]

I have a client that is attempting to convince me that it is possible to purchase multiple health insurance policies covering the same people and the same health events and to file claims to each of the insurance companies and collect the benefits in cash. The insurance policies are all 'limited medical benefits plans' which provide a fixed benefit for each service regardless of the actual cost. None of the insurance policies contain a coordination of benefits provision and several of the policies in question actually contain clauses that specifically indicate they will not coordinate benefits.

My gut says that this type of stacking isn't right and can't possibly be legal, but my gut isn't legal fact. Any insights?

Thanks!

 

[ecmst12]

Perfectly legal. That's what that type of insurance is for.

 

[cbg]

But if the insurance carriers find out that he is collecting multiple payments on the same injuries, my bet is that the least they will do is cancel the policies out from under him.

 

[izzie01]

Self insured policies usually do not coordinate with other plans. If there is no mention of coordination of benefits in plan then there is none. When submitting claims do you mention the "other" insurance? If you do then that is really all you have to do. Alot of dental practices do require that benefits be sent to them. Would there be an overpayment of the charges made by your office?
Is it the type of policy that they will be only charged a flat fee for a particular service ,ie flat fee=100 for a filling that would normally charge 200 for. Is the dental practice is part of a "collective, or in-network,or particiating provider" If the dental practice is a "participating provider" type of deal I would call and ask the net-work how to handle this.

 

[cbg]

Self insured policies usually do not coordinate with other plans.

I beg to differ. I have yet to see an employer-sponsored plan, be it fully insured or self insured, that did not coordinate benefits. For that matter, I have yet to see an individual plan that does not coordinate benefits, though I do not deny that some may exist.

No plan wants to pay out any more than they need to. Plans that do not coordinate benefits are few and far between.

 

[ecmst12]

The type of plan being discussed here is an individual supplemental policy, that would pay a flat amount for a specific list of procedures. They are nothing resembling the type of insurance you would get from an employer. If you have a question about that type of plan, you should start your own thread.

 

[lkc15507]

I think I agree w/ecmst. This seems to describe supplemental policies such as AFLAC, Combined, many others. In the case of a catastrophic event, I think our poster will be rudely awakened to the realities of health care coverage. ....If those are the only policies our poster has. Excuse me, poster's client has.