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On medical insurance policies, the coverage vary from insurer to insurer specially through group insurance provided by employers, cosmetics most of time is excluded from coverage for various reasons, yet, patients try to get cosmetic work done by asking the doctor to change the report so they can get it through insurance. What are your thoughts about this situation regarding ethics and honesty?
I had seen, intervened and negotiated many of these cases,
The customer should have adequate knowledge – which is covered and which is not,
If any doubts then the treating physician is the best person to explain the facts to his patients politely, most of the patients listen and adhere to doctors advises,
If done by compulsion or by choice it is breach of contract, it amounts to fraud, the provider can be legally penalized and the contract may be terminated.
The provider and the physician should stay honest to the contract and stick to ethical medical practice,
They should strongly discourage any of such demands from the customers.
Customer should have upto date knowledge about coverage .
If patient still have doubts then primary physician explain brielfy about facts to patients politely, usually most patients listen and adhere to doctors advises. If done by compulsion or by choice it is breach of contract, it amounts to fraud, the provider can be legally penalized and the contract may be terminated.
The provider and the physician should stay honest to insurer provider and stick to ethical medical practice
Such practice is not ethical and dishonest and not acceptable in medical insurance or other branches of insurances , besides the utmost good face one of the insurance principles prevent this and the insured should comply with this insurance principle and disclose the correct material facts when he asked insurance policy and fill the proposal form and also when he submit a claim and fill the claim form.
However , the insurance company when discover such dishonest act from insured's side has the right to cancel the insurance policy without refund premium and without any payment regarding the claim in question.
My best wishes.
first of all
the doctor or any health provider must work strictly with health insurance regulation and not exeeding any limits
never change the bill
As said remain honest in what ever business we do.
A transpent approach will never put a company in danger.
Once Customer knows about company's above said approach, they will never bring with situation
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Doctors and dentists usually deal with people who ask them to change a bill so it can be covered through insurance, how to deal in such situation?
