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Alex
Alex, Criminal Defense Lawyer
Category: Criminal Law
Satisfied Customers: 61
Experience:  Experienced, former Assistant State's Attorney and Assistant Attorney General licensed in IL and NY
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hi i already asked this question, i just want a second opinion,

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hi i already asked this question, i just want a second opinion, my spouse and i have each our own health insurances. his is better, so when the form came and asked if i had any other insurance i said no, because mine is so difficult to deal with. it is now 4 years later, and all of a sudden i received a form asking me if i have another health insurance. if i say i do, how much trouble will i be in?
Submitted: 5 years ago.
Category: Criminal Law
Expert:  Alex replied 5 years ago.
Hello. I imagine you would not be in any serious trouble for being honest about it now. How do they know that you did not get insurance newly? I assume that they do not ask since when - or do they? Finally, are there any claims in the past for which you think they might try to say you failed to notify them of other insurance, or primary insurance, and therefore they might try to deny you coverage, past or present?   As always it is very important to read your respective policies, which you have a legal right to receive copies of upon request. Any references and how they handle or treat other insurances should be contained in the policy as well. So I recommend you review that as well and ask questions of HR or the insurance companies if you are confused or needing direction as well. Of course I would not mention having fibbed in the past if I did not have to.

BotXXXXX XXXXXne - either insurance, or both, as the case may be, should cover you and your husband. Unless there is an agreement for one to be the primary insurance, meaning yours, then you should be ok for being honest about it now. Again, please read your policies to be sure. I do however suggest honesty because I would hate for them to use misinformation or future fibbing to try to deny coverage for either one of you on a costly claim in the future.

Also, you can always call a reputable local and licensed insurance agent who primarily deals in health policies for additional guidance and advice as well. Well, I hope this helps you both out a bit. Regards, Alex
Customer: replied 5 years ago.
hi, thanks for the answer, it asks your insurance and of course the effective date... we do have claims, my husband was never placed on mine, just because it is so awful and i pay the high premium along with his co. of $100 a month to cover me. i have you know routine stuff and some minor ilness, no major illness. i am also afraid, that they will ask my occupation which is in the medical field and say i had knowledge. i want to come clean , im just scared of incriminating myself. i also have heard that ny state decides that the primary insurance coverage is by your month of birthday, if this is true my husband would be the primary due to our birth months. mind you i have never fraudently used the insurance, they are all legit minor claims
Expert:  Alex replied 5 years ago.
Hello again. I think you probably have nothing to worry about especially if your claims have been minor and also since you correctly thought your husband's insurance was the primary one anyway. Can't you just give the effective date as of the current year which is the date it became effective as of this year? Most insurance policies are renewed by your employer and the employee on a yearly basis anyway. So answering about the policy's current effective date (which typically runs for one year) would not be incorrect. You can always write in "policy period for ________", where you would write dates for this year's policy period. This would not be a lie if your policy in fact was issued on a yearly basis. Normally, employer policies are renewed yearly in most places anyway. If you are really uncomfortable then I guess you can continue to say nothing and hope that no one ever finds out otherwise too. But I would hate to have you remain nervous over this for nothing or risk a bigger claim being denied for not sharing this information with each of the insurane companies. Again, in my experience they normally do not try to get the little guy who erred in answering a question due to confusion over which policy covers a legally married couple. Again you can ask HR or his HR or cal each of your insurances and tell them you are confused. Alternatively, you can simply read your policy and see what it says about non disclosure of another insurance.
Well I hope this helps you out a bit more. If you found my two answers helpful in any way kindly hit the accept button below. Regards XXXXX XXXXX you and to your husband, Attorney Alex
Customer: replied 5 years ago.
also they give a number to call, or a form to sign, would it be better to call because im not signing anything? on the other hand im afraid of the person asking me questions i dont know how to answer.
also am i correct that it is by the birthday month for new york state?
do you think they will try to go after me for being in the medical profession, and having some sort of prior knowledge despite the fact i am not in billing of any kind - im just afraid they will ask who my employer is and occupation and see i work in a hospital.. etc..
Expert:  Alex replied 5 years ago.
I do not think that they will highlight you even if you gave them your employer's name. You can also call the State of New York Department of Insurance for questions related to your policies and which one is primary too. Typically, the policies have provisions about this too. So as recommened in my last writing to you - please read these provisions too. As noted in the Department's writings online - "an employer may condition coverage of dependents upon the dependent securing coverage through his or her employment, thus making the employer’s policy secondary under applicable coordination of benefit rules. The insurer or HMO, however, may not unilaterally impose such a condition, nor may the HMO condition continuation of coverage on the employer’s imposition of such a requirement." This above information relating to an inquiry from an HMO member is directly taken from the Deaprtment's advisory opinion issued upon request of an insured. See,

http://www.ins.state.ny.us/ogco2004/rg040321.htm

In this opinion they also site some other insurance rules which mayh answer your concerns. For example, (n) Order of benefit determination rules. (1) The primary plan must pay or provide its benefits as if the secondary plan or plans did not exist. A secondary plan may take the benefits of another plan into account only when, under these rules, it is secondary to that other plan. . . . (3) The order of benefit payments is determined using the first of the following rules which applies: (i) the benefits of a plan which covers the person as an employee, member or subscriber . . . are determined before those of a plan which covers the person as a dependent; . . . .

As this opinion points out the coverage and order of application is based on the provisions of each of the policies first and foremost. Any other rule is probably based on a case by case basis. However, you can always call the Department of Insurance and pose your question about if the last name rule applies to you. Given the confusion over provisions that exists among insurance non-professionals, submission of a claim in the belief that the insurer, including an HMO, was primary when the insurer was in fact secondary, under the circumstances described, appears to lack the intent necessary to constitute insurance fraud. In the example given the Board found - "Accordingly, if there is no insurance fraud, the HMO may not terminate the client’s coverage." Why I bring this up is because based on the rules in place it would seem you did not intentionally do anything to defraud the insurance companies and therefore they should not hold that criminally against you. Just my opinion in reading the rules. You may want to ask them directly too. Or look at the other opinions they have published on the net to help folks like you too.

Hope this helps you out. If you found my answer valuable kindly hit accept button too. Thank you in advance. Attorney Alex


Alex, Criminal Defense Lawyer
Category: Criminal Law
Satisfied Customers: 61
Experience: Experienced, former Assistant State's Attorney and Assistant Attorney General licensed in IL and NY
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