DH's company doing a dependant audit for health care. Your thoughts?

[dicar123]

If you can black out some info, it doesn't seem that intrusive.

Can't really blame them, everyone is looking for ways to cut their costs and fraud can be a big one.

 

[mum4jenn]

My Dh's insurance is doing this also but they sent us a form listing the dependants currently on his insurance and since it is correct we do not have to do anything.

 

[MrsToad]

Nothing particularly new. While my DH's company does not ask for that much, when I was covered on his insurance, we had to certify that I was not eligible for group insurance at my employment twice a year. Random people are audited periodically -- finding out a spouse is insurance eligible at their company is grounds for termination.

We also have to send our college student's schedule and bill each year to prove he's a full time student.

This is similar to what DH's employer does. If you want to add a spouse to the employee's coverage, you have to get a letter from the spouse's employer noting that they either do not provide coverage at all, or that the coverage is less than a certain percentage of the coverage available at DH's employer. If the spouse is self-employed, the spouse just has to submit a letter that he/she hasn't purchased any other insurance. I think we've only had to submit the letter once so far, when a new insurance company was selected.

College age students also require a copy of their course schedule/registration.

 

[jackskellingtonsgirl]

We had to do this last year.

I had to mail in a copy of DS's birth certificate, a copy of our marriage license, and a copy of a utility bill with both names listed. I know the tax forms were one of the things we could have chosen to submit, but I chose not to.

I guess they aren't doing it this year, because I know we had the audit info in June of last year and it was due in August. I remember because my mom had cancer surgery in June. We had the paperwork before I flew up for her surgery, and while I was there I panicked thinking I missed the deadline. I called DH and he read through the packet and found it was due in Aug.

 

[*Flower*]

DH and I are both employed by the same company, and the only coverage that we have through them is our Dental and FSA.

We still got audited this year, and all we had to do was send a copy of our tax return (with all the financials blacked out), and received a response a few weeks later that they were satisfied.

This is the first time that our company opted to do this.... VERY freaky.

 

[candykisses]

I can understand why the company is doing the the audit. If I can blackout financial information I'll be happy. I won't be to thrilled if I have to pay to get birth certificates with seals.

I've been with the same company for 33 years, the president and I were laughing last week about this because he was at my wedding and the baptisms of my boys. I told him I was going to call him as a witness if the auditing group doesn't accept my paperwork.

 

[Bluestars]

If you can black out some info, it doesn't seem that intrusive.

Can't really blame them, everyone is looking for ways to cut their costs and fraud can be a big one.

We have had employees at the company I work for try to enroll people who were not their legal dependents. One person enrolled her ex husband and his child as if they were currently married. Another person put his friend down as his child. Someone else put down her grandmother. Someone else put down her grandchild as if she were her own child. The list goes on. You wouldn't believe it.

 

[aprilgail2]

Budco is doing ours right now also. I am happy they are doing it- they said there are hundreds that are not eligible that are being covered right now!! I hope they prosecute those that they catch!!

 

[lsyorke]

I just had to do this for hubby's old employer(he's retired), but it went directly to the State of New Jersey, where he worked for 30 years. They already know everything about us so it didn't bother me at all. This is the first time they have ever asked for this information....he worked for them for 30 years, no questions or proof ever asked for.

Better to make sure that all who are claiming benefits are entitled to them.

 

[Nicoleclaw]

We just had to do this at the school district where I work. First we had to show our license to get our paychecks one week!
Then we had a couple weeks notice to get the first page of our most recently filed tax return with our name and spouse, marriage certificate, birth certificate, and ss cards for all involved. Atleast they had someone at each school though so we did not have to mail in.

 

[KatheeME]

My company did this, for the first time, in February. It was to catch employees that listed children or spouse that were not longer eligible for coverage. At first I also resented it also, but know I have come to realize it's to catch the cheaters. I did have to send in our tax returns, but we were told to white out our social security numbers and all the money amounts. It took forever, but it was worth it to protect my privacy.

 

[lsyorke]

We only had to send the top portion of the first page of our tax return that showed the dependent and spouses name.

 

[3boymthr]

People I have seen claims submitted for/enrolled incorrectly on the plan:

The next door neighbor (yeah, we found this when the neighbor tried to get pre-certified for a transplant)
Grandchildren
Children well over the age of being a student (25+)
The ex-husband and his current wife
The ex-spouse's children
Foster Children
A domestic parter and a spouse (don't wanna know what was going on there)

And this one is the best....

The family dog

Seriously, I kid you not. A very famous person did this by the way. Someone who could well afford to pay for the dog's bills. (Which totaled over $10,000 for when the dog attend a private "retreat" with the member ) Nope can't reveal names that would violate HIPAA. All I can say is the man had millions and millions in the bank.

So the fraud happens everywhere, every day. And it's costing insurance companies and especially self-funded plans a fortune.

ETA - allowing this fraud increases everyone's insurance premiums so if you know it's happening you should report it. All insurance companies have a fraud division where you can call to report things that should be investigated.

If your insurance company is conducting this type of audit, I would just confirm that the company performing the audit is legitimate, but you should know that these types of audits have been going on for years at self funded plans, just without getting the corporations and all employees involved (only the one's about whom we had questions - like the employee with a domestic partner and spouse).

 

[mjantz]

Nothing particularly new. While my DH's company does not ask for that much, when I was covered on his insurance, we had to certify that I was not eligible for group insurance at my employment twice a year. Random people are audited periodically -- finding out a spouse is insurance eligible at their company is grounds for termination.We also have to send our college student's schedule and bill each year to prove he's a full time student.

I'm not fond of the bolded part. I recently got a new job that offered insurance (my first ever with benefits). However, I would rather keep my coverage through my DH than have to go through the hassle of filling out all the paperwork at all my drs for the new insurance. Honestly, I think I'd pay extra to keep my coverage with DHs company.
Thankfully they don't charge extra or force me to take my new jobs coverage and I'm praying they don't start.

 

[LindaG4458]

Apparently Medicare is also doing a lot of auditing. DH's aunt, aged 90, just had her physical therapy refused because of some question dating back to a claim in 1992! She was very upset and mentioned it to her doctor. He said several of his patients were having the same problem. She finally cleared it up but she was so upset she became physically ill and saw another doctor for the resulting symptoms.

 

[bumbershoot]

My company did one last year. I don't have any dependents so I don't know what was required. My company allows domestic partners, I wondered how they prove that. It's more than just living at the same address.

While we weren't audited, I was covered as domestic partner on hubby's insurance before we got married. We *could have had* to submit the lease in both our names, bank account info (not big info, just that we were both on it), had to tell them how long we'd lived together...that sort of thing. Anyway, a company that allows coverage for domestic partner has their certain rules for it, and those rules would probably apply for an audit as well. Hubby just reminded me that we never actually had to submit things, but at the time we knew what they would want to see if they wanted to see it (but I went to company picnics, co-workers were invited to the wedding, etc...they knew I was legit anyway).

 

[golfgal]

They may be looking for who you are claiming as a dependent; and how that compares to who they are covering.

At other jobs I've had, I've had to show birth certificates & marriage license when I was hired, but never a tax return.

Be glad your employer's insurance covers your spouse & kids; my new job does not. They will pay half of my premium; but nothing for DH & my 2 DSs. I have to pay $175, per week, if I want their insurance.

This is actually fairly common and really not all that expensive.

There are so many people out there abusing the system that companies are stepping up to save costs, especially if the Health Care bill goes through--which is going to put a LOT of small businesses out of business because they won't be able to afford to pay the insurance premiums and since the government is insisting on companies not being allowed to rate people for preexisting conditions EVERYONE'S premiums are going to go WAY up-double or more probably. This is why companies are making sure they aren't paying for people they don't have to.

 

[MrsToad]

I'm not fond of the bolded part. I recently got a new job that offered insurance (my first ever with benefits). However, I would rather keep my coverage through my DH than have to go through the hassle of filling out all the paperwork at all my drs for the new insurance. Honestly, I think I'd pay extra to keep my coverage with DHs company.
Thankfully they don't charge extra or force me to take my new jobs coverage and I'm praying they don't start.

The way DH's company explained it to us is that they are just trying to make sure employers are each paying their fair share of employee/family premiums. For example, DH's employer currently pays all of the employee premiums and a nice portion of the spouse and children's premiums. If the spouse's employer offers insurance as a perk and yet the spouse stays on the DH's policy, DH's employer would really be paying more than their share by paying a portion of the spouse's coverage and the spouse's employer would be, ultimately, paying less than their share since their own employee isn't taking the insurance through them. It does seem to make sense from the employer's viewpoint.

 

[manning]

Apparently Medicare is also doing a lot of auditing. DH's aunt, aged 90, just had her physical therapy refused because of some question dating back to a claim in 1992! She was very upset and mentioned it to her doctor. He said several of his patients were having the same problem. She finally cleared it up but she was so upset she became physically ill and saw another doctor for the resulting symptoms.

If they crank up the auditing big time medicare could become solvent !!!!!

 

[ameraumi]

Be glad your employer's insurance covers your spouse & kids; my new job does not. They will pay half of my premium; but nothing for DH & my 2 DSs. I have to pay $175, per week, if I want their insurance.

This is actually fairly common and really not all that expensive.

Seriously, that is not expensive? I sure think so considering we paid half of that and I cringed at it. Health care premiums are getting out of hand, that is for sure.

I have never heard of an audit like this. I guess I learn something new everyday.