Insurance companies & medical benefits in the US

[Bob.Kerns]

Originally Posted by QuadSquad

Perhaps I misunderstood the stated intent. My perception of the statement

"Isn't there a way to work around that insurance thing? How 'bout the doc prescribes a motorized wheelchair or a 3/4-wheel scooter. Then you pick up the device and promptly sell it and put that money toward the cost of a Segway."

was that one would accept the physician prescribed device with the sole intention of selling it to acquire something that the paying entity was not contractually obligated to pay for.

That my friend is a fraudulent activity, there is no way in my mind to justify it.

If you aren't happy that Segways aren't a covered benefit ( i'm certainly not) lobby your state and federal lawmakers, appeal to the insurance carriers, start your own cooperative efforts. A group of us early adopters here on Segwaychat collectively bought a Segway for a young man.

But for heavens sake don't twist ethics in some perverse way to justify illegal behavior no matter how difficult it would be to prove.

I have the advantage, I guess, of knowing Jim already has his Segway and how he got it. (An awesome story in itself). So to me, this discussion has never been about justifying anything, on legal, ethical, or moral grounds.

The problem is, neither Jim or myself can figure out exactly what would constitute fraud -- and I added ethics and morality to the list of questions. A lawyer can at least help you be sure to stay legal -- and, as I pointed out, keep you from avoiding a perfectly legal path out of unfounded fear.

I think I could make at least as good a case that it is fraud for insurance companies to sell insurance, and then refuse to cover a cheaper, better alternative, and insist you use a more expensive, less healthful piece of equipment. (Still not a very good case).

I'd like to see a court decision that would support -- at any point -- selling used medical equipment, for any purpose or timing, as being fraud. Not because I dispute it, but because it would clarify the question.

My interest in the question is real, and not limited to Segways (I paid for my own). I've had my wheelchair for nearly 10 years now. Would it be fraud for me to sell it now? Why, or why not? What about other equipment I have now or acquire in the future?

Selling some of that might help me raise cash for other medical stuff I need. Surely I'm not required to continue to clutter my garage with three walkers for all of eternity? Or maybe I can donate it?

I can make up my own mind on the ethics and morality, but I don't understand the legal aspect at all.

Except I take it as a given that lying to the insurance company to get something is fraud. And willful withholding of information you had a duty to disclose would amount to the same thing.

Beyond that?