Settlement with insurance company rather than surgery (hospital, claim, patient)
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I hate when people ask questions for someone else, but my friend is not in adequate health to address this issue himself. Sorry.
My friend has been diagnosed with a cancerous condition that will require expensive surgery. The surgery will greatly reduce the quality of his life, and there is no guarantee the Cancer will not return. He has health Insurance which will pay for a large majority of the surgery cost and hospital care. But he is thinking he may prefer to skip the surgery and just let the Cancer run its course.
Can he enter into a settlement with the Insurance company to alleviate them of their obligation to pay for the surgery and all future care? This would save the Insurance company money and would allow him to leave some money to his family. If so what would this be called?
He does not have life insurance, and I am not talking about a viatical settlement.
I am intrigued by this concept.
So a person could enter into a 'settlement' with their insurance company whereby they would get a cash payment in lieu of any further payments.
The ins company would benefit because they would be 'off the hook' for any further payments.
The patient could use the money for palliative care and burial expenses.
It actually sounds like a better deal for the ins co frankly.
I am intrigued by this concept.
So a person could enter into a 'settlement' with their insurance company whereby they would get a cash payment in lieu of any further payments.
The ins company would benefit because they would be 'off the hook' for any further payments.
The patient could use the money for palliative care and burial expenses.
It actually sounds like a better deal for the ins co frankly.
No, the insurance company is only on the hook for care that is actually delivered. If the patient chooses not to be treated, that will make the insurance company very happy. However, the insurance company will not pay the patient anything in order to avoid paying for treatment.
I am intrigued by this concept.
So a person could enter into a 'settlement' with their insurance company whereby they would get a cash payment in lieu of any further payments.
The ins company would benefit because they would be 'off the hook' for any further payments.
The patient could use the money for palliative care and burial expenses.
It actually sounds like a better deal for the ins co frankly.
Essentially correct. Thank you for understanding the question.
There is not a mechanism for this in a health insurance policy. The only way he could get some money "back" would be to drop the policy totally and save premiums, he would have to pay the ACA fine though. He has already alleviated the health insurance company by choosing not to seek treatment. Does he still work? If so, he may have a small amount of life insurance through an employer, often with a benefit that if he is terminal he can take a portion of the death benefit to use while he is still living, the accelerated death benefit. That is typically somewhere between 50-90% of the death benefit.
He has already alleviated the health insurance company by choosing not to seek treatment. Does he still work? If so, he may have a small amount of life insurance through an employer, often with a benefit that if he is terminal he can take a portion of the death benefit to use while he is still living, the accelerated death benefit. That is typically somewhere between 50-90% of the death benefit.
Thank you for your feedback that there is no mechanism for this in the insurance industry.
I thought my OP was clear, "he is thinking he may prefer to skip the surgery", so he has not "already alleviated the health insurance company by choosing not to seek treatment. "
He is still does not have life insurance. Any life insurance from any source.
Odds are the insurance companies wouldn't be able to do this even if they wanted. Regulations are in place to ensure the insurance companies pay claim for service rendered and not attempt payment in lieu. Payment in lieu is viewed as offering a financial incentive not to have care. I can't think of a single state who's regulations would allow such a practice.
I suspect that if someone approached the insurance company with such an offer, it would be met with suspicion of insurance scam and most likely the company would be reporting that person to every criminal and fraud investigative body in the USA. Not only will that person not be getting any money, but their every move will most likely be monitored looking for some evidence of fraud.
Thank you for your feedback that there is no mechanism for this in the insurance industry.
I thought my OP was clear, "he is thinking he may prefer to skip the surgery", so he has not "already alleviated the health insurance company by choosing not to seek treatment. "
He is still does not have life insurance. Any life insurance from any source.
If he doesn't seek treatment, the insurance company won't be on the hook for anything so it amounts to the same thing.
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