Page 368 - Ebook health insurance IC27

The Insurance Times

 Encouraging network hospital usage by providing additional benefits for
treatment taken from partner providers.

 Cost effective special insurance products with all planned hospitalization to be
taken only on network hospitals.

 Educational posters and sessions to explain fraud and its penalties.
 Increased use of technology like using anti fraud software's to throw triggers for

fraudulent claims. The software's uses a unique combination of data mining
capabilities, visualization techniques and reporting tools, which can identify
potentially fraudulent before a claim is paid, or retrospectively analyze providers'
statistics and past behaviors to flag suspicious patterns.
 Advanced analytics and easy integration with your claims payment processes for
improved recovery and prosecution efforts.
 Private and public insurance players forming anti fraud association.
 Psychological profiling and use of lie-detectors. (Insurance companies in England
uses this tool)

Insured's Role
 Protecting Health Insurance Information: The member should never give their

health insurance number to telephone or door-to-door solicitors in a "free
medical camp"
 The insured needs to understand any "free" treatment that features "no out-of-
pocket expense" or "no deductibles,"
 The member should read their benefit and billing statements to ensure that has
actually received the treatments that were paid for, and report any apparent
discrepancies to concerned authority.

372 Guide for Health Insurance