Hiding a test result

February 10, 2011

How to avoid committing insurance fraud

Q. An established patient asked to be tested for HIV. He is very concerned about his insurance company finding out and asked if he can have the testing done under a false name. I advised him if the tests were to be positive and he failed to be truthful in an insurance application, he would be committing insurance fraud and that when a claim did come forth for some chronic related ailment that the insurance company would almost certainly deny coverage. Am I correct?

A. Your observations are entirely accurate. First, if the specimens were submitted under a false name, the insurance coverage would not apply anyhow since all the insurance data would be associated with a different name. If he does not want his insurance company to know, he should pay cash. You are completely accurate in terms of the potential insurance fraud issues pertaining to lying about HIV status if asked.