re: A question about health insurance and marriage

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It's called LYING

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So if you lie about your age and say you're 40, are you forty, or just a liar?

I'm going to have to go with, 'you're not 40, you're a liar.'

Therefore they are either married and she is his wife, or they are not married and she is NOT his wife - regardless of any sort of mendacity.

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Try to keep up, Wild.

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I'd imagine the instances of fraud are low enough in situations like this that it's more efficient to go case by case than to do background checks on every couple.

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Exactly what I would have thought. But in this case the insurance company is going after EVERY couple.

Today I had to make a copy of our marriage certificate and provide a copy our joint tax return. I stress the word 'and' not 'or.' They demand both.

Their explanation is 'to hold down costs'. If you can read between the lines it means 'stopping fraud.'

This company does not insure the general public. Only employees of the hospital and apparently some people are lying about their spouses and children.

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Yes. But let's say that Mary only gets blood work and an MRI once a year. Will they audit for that?

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No way to tell. They won't appear to be targeting one particular individual. The audit should encompass the entire group of employees.

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Only employees of the hospital and apparently some people are lying about their spouses and children.

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It happens a lot. Thus the audits are becoming more and more popular. That's one of the first ways a consultant will tell a group they can save money is to audit their employees and their dependent status.

Coming from you Zach, that's a compliment.



Next time, though, if two people say they aren't married, you can go ahead and assume that they're not man and wife. I know you might struggle to understand that, but it's just the way things are.

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Is this a self insured or small group? My wife is employed by a hospital and I'd jump on her insurance in a heartbeat. I can see why they're checking if the benefits are good.

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It's a hospital complex that my wife works for. It's a great deal. I jumped on her insurance as soon as I retired.

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But since common law is not registered at the court house how do you know that the woman getting the medical treatment is really the employees common law wife?

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You are just going to have to trust them on it.

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Let's say John works for the Acme company. His health insurance covers his wife Mary. Mary goes to the doctor more than John but the insurance covers it. One problem. They are not married. They just live together. How does the insurance company know? Or do they care?

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Some companies - usually large national corporations - are fine with including 'partners' on employee policies.

i'm sure they initially only did this to cover those who couldn't be married by law, but soon realized they have to cover all 'partners'.

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his wife Mary

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fraud