Health Insurance Rebate- Returned Glasses?

• 

  boomramada on 30/01/2025 - 22:35

  +1

  They going to call bikies on you!!

  • 

    jv on 31/01/2025 - 00:06

    +2

    🍪

• 

  Dollar General on 31/01/2025 - 05:23

  +1

  If you paid the full price, how does the store know if you claimed and what health provider you are with?

  Stop over thinking it

• 

  Ocker on 31/01/2025 - 07:42

  Let your conscience be your guide

• 

  AustriaBargain on 31/01/2025 - 09:01

  You don't think that one day soon the insurer isn't going to follow this up? Or hasn't already followed it up and one day soon the optometrist will complete more paperwork to follow up that follow up? Is $200 worth committing insurance fraud. Though I guess you could just claim ignorance if you get caught.

  • 

    freefall101 on 31/01/2025 - 11:06

    Why would the insurer follow it up? Invoice provided, rebate paid. They don't go around double checking if every invoice has been refunded. Since the optometrist didn't process anything to do with the rebate, they wouldn't contact the the insurer.

    If you called in to try pay them back there's a good chance they'd tell you to keep it because it's too hard to process. OP paid premiums and used premiums, that the glasses were returned doesn't really matter much to them.

    • 

      YesPleaseThankYou on 31/01/2025 - 21:12

      If you called in to try pay them back there's a good chance they'd tell you to keep it because it's too hard to process.

      I agree with your above assessment.

      The OP should email the fund and advise of the situation, giving it the opportunity to decide whether it wants the money repaid.

• 

  Sye on 31/01/2025 - 09:19

  +1

  This should be posted as a Deal. "With this One Simple Trick you can make $200 and get up to 10 years free food and accommodation".
  /$

  • 

    JIMB0 on 31/01/2025 - 09:52

    The terms and conditions state that you must return the $200 if receiving the free food and accommodation. If you don't have the $200 you can earn it making number plates while receiving the free food and accommodation.

  • 

    DashCam AKA Rolts on 31/01/2025 - 14:56

    +2

    Returning glasses makes cents. Cheers.

• 

  theHMASfriendship on 31/01/2025 - 09:38

  +4

  Now repeat for infinite money

• 

  immrnonamehello on 31/01/2025 - 10:04

  +1

  They couldn't care less for $200. The "lost" money to them is already built in to the monthly premium you pay.

• 

  eltito on 31/01/2025 - 15:24

  Interestingly their systems show the full purchase price as the rebate didn’t go through hicaps, and the returns slip I had shows the full price I paid. Am I under any obligation to tell my health insurer that I got a refund? Will the optometrist automatically hand a portion of funds back? Surely I haven’t accidentally discovered a loophole lol. Also why do people bother buying glasses online if the prices aren’t much cheaper than in store and your chance of getting something wrong is quite high?

  ** Am I under any obligation to tell my health insurer that I got a refund?**
  There is potentially some kind of T&C or something along those lines within your fund which notes you need to notify if there is a change in circumstance.

  Will the optometrist automatically hand a portion of funds back?
  The optometrist will refund what you paid them - they don't care about anything after the fact

  Surely I haven’t accidentally discovered a loophole lol. Also why do people bother buying glasses online if the prices aren’t much cheaper than in store and your chance of getting something wrong is quite high?
  It is a loophole to an extent, but I'd assume it's also considered fraud and likely wording somewhere in your fund noting this change needs to be reported. But like someone previously said, they also build this into your premiums.

  I used to work in health insurance, plenty of people do dodgy stuff and get away with it, and i'm sure there are others that don't get away with it, but I doubt you will be on your health insurers radar for this.

• 

  YesPleaseThankYou on 31/01/2025 - 21:10

  1. You haven't named the insurer, but the situation would most likely be covered by the insurer's Fund Rules. Look them up.
  2. Sounds like insurance fraud to me.
• 

  Muppet Detector on 02/02/2025 - 07:33

  +1

  I really do think you're in fraud territory now as it is generally understood to be obtaining goods by deception.

  Whilst you weren't being deceptive when you initially made the insurance claim, you no longer have the glasses to continue the claim against your policy.

  The key element to establish fraud is that a person acts dishonestly.

  In order to determine if your conduct was dishonest the court will compare your conduct to that of reasonable and honest people in light of ordinary standards.

  Additionally, court must be convinced that you knew you were acting dishonestly when measured against those standards.

  If not a legal obligation, it is definitely at least an ethical responsibility. If detected by health fund, it is likely they would terminate your policy and refuse to offer you insurance or other services they may offer in the future.

• 

  Muppet Detector on 02/02/2025 - 07:58

  +1

  In the HIF website they say

  https://www.hif.com.au/health-insurance/reporting-fraud

  Fraud is defined as wrongful or criminal deception intended to result in financial or personal gain. In the Health Insurance industry, this would be best described as a dishonest act or a deliberate deception where a person received a benefit payment they are not entitled to, or the use of false and/or misleading information to claim a benefit.

  •Claims for services or treatments that did not occur.

  I ASSUME that most PHI would have similar views.

  Make of that what you will.

  I initially went into research mode because I was quite sure that this wouldn't turn out to be insurance fraud (because you didn't obtain the goods by deception, but rather kept the goods by deception.

  But after I dug out my old notes and delved deeper online, it became quite convincing to me that this was. It seems I was initially interpreting the elements of insurance fraud too literally. (That being the definition of obtain).

• 

  Muppet Detector on 02/02/2025 - 08:07

  +1

  At the very least, contract law will not allow you to keep the goods and the money.

  In saying that, insurer has to catch you first and if they think you are doing the wrong thing, have to seek confirmation and remedy through legal avenues if you refuse to give the money back when they ask (will likely start with letter of demand then escalate through mediation channels before entering the courts) and I'm not sure how much effort or expense they would go to in order to recover $200.

  • 

    YesPleaseThankYou on 02/02/2025 - 09:37

    Great analysis in your posts above. There's no doubt that what the OP has described is fraud.

    You say:

    I'm not sure how much effort or expense they would go to in order to recover $200.

    I think the following would be the likely outcome:

    If detected by health fund, it is likely they would terminate your policy and refuse to offer you insurance or other services they may offer in the future.

    Then, depending on the wording of the question, when the OP takes out other policies (eg, home and contents etc), they may have to disclose that they have been refused insurance.

    If the OP is in the Australian Public Service or other sensitive sector, if the fraud is uncovered, then there may be other more serious implications, including termination of employment.