Social Question

JLeslie's avatar

Is using health insurance to get OTC items for others ok?

Asked by JLeslie (65789points) June 19th, 2022 from iPhone

Someone just posted in a Facebook group I belong to that their insurance lets them have $100 worth of OTC items and since he can’t use it all he wants to know where to donate items.

I responded it MIGHT be insurance fraud. Everyone on the thread says it’s not. I’m not a lawyer. I think it’s very nice people want to help others this way.

What do you think? Is it legal?

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21 Answers

ragingloli's avatar

Legal, illegal, scheißegal.
What matters is if he can get away with it.
You are getting shafted, collectively and individually, by the insurance and healthcare industry on a daily basis. You should not feel an iota of guilt when returning the favour.

elbanditoroso's avatar

@JLeslie I have the feeling it is technically illegal, and if the insurance people were ever to audit the person, he/she would be in some sort of throuble.

On the other hand, the changes of any insurance company going to that length to track down anyone for $100/month – it just isn’t going to happen. They would spend far more than that on lawyers and investigaors. And even if they did, they know that most people throw away their receipts, so what evidence would they have?

My guess is that the insurace people sort of built that into their pricing.\

Is this a Medicare Advantage plan that does this? If so, I wonder how much he/she is overpaying for their plan…

HP's avatar

One thing is certain. It’s foolish to advertise the intention on Facebook

smudges's avatar

@elbanditoroso Yes, Medicare Advantage. I have it too.

JLeslie's avatar

It probably is Medicare. People on there are saying they buy hygiene products like toilet paper, tampons, and donate it. I mentioned it might be insurance fraud and people on there are trying to twist it into I don’t want to help those less fortunate, even though I’ve said a zillion times how nice the idea is.

They also don’t understand how it costs EVERYONE more if more money than necessary is allotted for the benefit. People are amazingly obtuse, but then we all know that.

@ragingloli Someone on the Facebook thread also pointed out the way we are scammed by health insurance and our medical system in the US. I completely agree with that. I just still think if the OP is going to “use” the system he should know whether it’s legal or not so he is making a decision with his eyes open, and maybe resist posting on a public forum about it.

@HP That’s what I was thinking. Stating his plans on Facebook sounds not too smart.

jca2's avatar

How would the insurance company even know? Let’s say the person bought various items (band aids, contact lens saline, Kotex, etc.). The insurance company has no way of knowing whether the person kept it in his own bathroom, has a second house and maybe took some stuff there, or what. It wouldn’t be worth their time to pursue it. Even if they had a warrant to go into his house (which of course they wouldn’t but just hypotheticallY), the fact that the person didn’t have those items in his or her house means nothing.

I also think that if the person stated their intentions on Facebook doesn’t mean they actually did it, and even if someone took it to mean they did it, does that qualify as an admission of guilt? They’re not under oath.

Just being technical with playing Devil’s Advocate here.

JLeslie's avatar

A bunch of people on the thread say they do it.

Jeruba's avatar

I’d say that using a health insurance allowance to get OTC items is okay.

Once they’re yours, you can do what you want with them.

SnipSnip's avatar

It depends on the insurance contract.

Jeruba's avatar

I doubt that you’re expected to remember which box of tissues or bottle of Benadryl you bought on your insurance allowance when you offer it to a guest or a shelter.

JLeslie's avatar

@Jeruba Agreed, but these people are saying every month they buy products and donate. It’s not a bottle of Benadryl or box of tissues, it’s much more than that times a lot of people.

Morally, I like that they are helping people, especially people who really need the help, but if lots of people are doing this every month that probably adds up to a lot of money.

snowberry's avatar

My insurance company spams me with a chance to buy over-the-counter meds, etc through them. Apparently it’s legal. In fact, they even send out a catalog every few months. I rarely ever purchase such products, so I don’t bother with their catalog.

Forever_Free's avatar

I wouldn’t worry about it.

JLoon's avatar

Yes.

In the circumstances you describe there’s nothing improper with purchasing available non-prescription products covered as a free benefit under an authorized health insurance plan, and them using or sharing them in any way you choose. Legally it’s a non issue, and as a healthcare consumer you’re protected under the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

“The Privacy Rule protects all individually identifiable health information held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral.

“Individually identifiable health information is information, including demographic data, that relates to:

• The individual’s past, present or future physical or mental health or condition,
•The provision of health care to the individual, or
•The past, present, or future payment for the provision of health care to the individual.

But beyond that, the best advice for anyone looking for accurate, reliable, and truthful info on healthcare or any other subject is just avoid online forums.

After 20 years sites like Facebook, Twitter, Redit, Quora and others have multiplied collective human stupidity X 10.

elbanditoroso's avatar

@JLoon your quotes are about privacy, not about purchasing.

JLeslie's avatar

Is this all Medicare plans that get this allotment? How does it work? It might help my in-laws. Thanks!

elbanditoroso's avatar

No @JLeslie – there are two types of Medicare extra plans

a) Advantage Plans throw a lot of extras into the coverage (like this) but generall restrict you to THEIR doctors (like an HMO) and their hospitals. The roll the premium plus the extras into one fee (which is how they have the money to pay for $100 in supplies every month. It’s your money)

b) Supplemental Plans are more traditional, extra insurance. Less gimmicks, but with the ability to go to any doctor in or out of network.

read this

JLeslie's avatar

^^Thanks. It’s so much information to absorb.

elbanditoroso's avatar

When I turned 65, it took weeks (and several handbooks and conversations) to understand it.

JLoon's avatar

@elbanditoroso – Follow the link and read the details directly from the source. The privacy provisions apply to all aspects of healthcare, including point of sale transactions for medical supplies at retail outlets.

…Or you can flog this question here, on Facebook, or Twitter, or wherever and collect as many bad answers as you want.

Have a nice day.

WhyNow's avatar

A friend you say… hmmm… did this ‘friend’ ask you to buy bleach for their COVID problem?

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