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Help needed on Insurance companies
story teller
#21 Posted : Thursday, May 23, 2013 1:21:43 AM
Rank: Member


Joined: 6/25/2010
Posts: 415
mawinder wrote:
Wazuans please assist my friend especially those with experience in Insurance matters.


I swear it's a strange world..whatever happened to honest living?
It's not hard to make decisions when you know what your values are.
mawinder
#22 Posted : Thursday, May 23, 2013 8:08:52 AM
Rank: Elder


Joined: 4/30/2008
Posts: 6,029
story teller wrote:
mawinder wrote:
Wazuans please assist my friend especially those with experience in Insurance matters.


I swear it's a strange world..whatever happened to honest living?

The end justifies the means!!!!
mawinder
#23 Posted : Thursday, November 07, 2013 3:18:55 PM
Rank: Elder


Joined: 4/30/2008
Posts: 6,029
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.
maka
#24 Posted : Thursday, November 07, 2013 3:22:03 PM
Rank: Elder


Joined: 4/22/2010
Posts: 11,522
Location: Nairobi
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.


He he he...
possunt quia posse videntur
nakujua
#25 Posted : Thursday, November 07, 2013 4:05:25 PM
Rank: Elder


Joined: 12/17/2009
Posts: 3,583
Location: Kenya
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.

smile , a condition requiring that much will have to involve some major surgical operation - someone willing to have a scalpel rip through their body will have worked for that cash.
mawinder
#26 Posted : Thursday, November 07, 2013 4:23:40 PM
Rank: Elder


Joined: 4/30/2008
Posts: 6,029
nakujua wrote:
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.

smile , a condition requiring that much will have to involve some major surgical operation - someone willing to have a scalpel rip through their body will have worked for that cash.

How will they know or do they demand to see the scars?
MKWASI
#27 Posted : Thursday, November 07, 2013 5:33:32 PM
Rank: Member


Joined: 4/20/2012
Posts: 888
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.




A friend of mine.. Milking the insurance dry....Honestly if one can go to such extent, he also needs to see Dr Frank just in case he is on his way to the mental hospital.
mawinder
#28 Posted : Friday, November 08, 2013 9:17:58 AM
Rank: Elder


Joined: 4/30/2008
Posts: 6,029
MKWASI wrote:
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.




A friend of mine.. Milking the insurance dry....Honestly if one can go to such extent, he also needs to see Dr Frank just in case he is on his way to the mental hospital.

Why struggle with plots,sijui stocks etc when there is easy money.Even if it means seeing Frank Njenga it is okay.He could as well as move from one insurance company to the other every year.Remember the NHIF scandal in the ninenties.
quicksand
#29 Posted : Friday, November 08, 2013 10:08:48 AM
Rank: Veteran


Joined: 7/5/2010
Posts: 2,061
Location: Nairobi
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.


Hii utashikwa. Insurers have doctors and pharmacists on payroll who examine courses of treatment (diagnosis processes, fees, procedures and drugs prescribed).
This is an exact science....Sometimes even figures like 150,000/- invite keen examination, wacha hiyo yako ya 2.5 million ...things like prescription of fancy drugs when there are equivalent generics will get somebody under the radar ...remember doctors and pharmacists licenses can be revoked for fraud and malpractice, and insurers can delist hospitals where there is suspected fraud. Hard to get people to play ball.
Magigi
#30 Posted : Friday, November 08, 2013 10:23:21 AM
Rank: Elder


Joined: 3/31/2008
Posts: 7,081
Location: Kenya
mawinder wrote:
A friend of mine wants to burn down his warehouse to be compensated for the loss of "property",any wazuan who has done this before?He is tired of paying premiums and wants to eat from the insurance company.

I know of a guy (a lawyer) who directed his car to a cliff ... But forgot to break his arms and legs!. He fell flat on his ploy!
nakujua
#31 Posted : Friday, November 08, 2013 11:07:16 AM
Rank: Elder


Joined: 12/17/2009
Posts: 3,583
Location: Kenya
quicksand wrote:
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.


Hii utashikwa. Insurers have doctors and pharmacists on payroll who examine courses of treatment (diagnosis processes, fees, procedures and drugs prescribed).
This is an exact science....Sometimes even figures like 150,000/- invite keen examination, wacha hiyo yako ya 2.5 million ...things like prescription of fancy drugs when there are equivalent generics will get somebody under the radar ...remember doctors and pharmacists licenses can be revoked for fraud and malpractice, and insurers can delist hospitals where there is suspected fraud. Hard to get people to play ball.

Unless its an inside job, some medics(mostly nurses) employed by the insurance companies to follow up the cases collude with doctors and patients to get a few coins - but its mostly small amounts < 100k, anything more than that attracts attention of the auditors and a few have been caught when they attempted instant major gains.
xyzee
#32 Posted : Friday, November 08, 2013 12:03:20 PM
Rank: Veteran


Joined: 1/9/2009
Posts: 1,262
medical claims over a certain amount requires preauthorization, insurance companies also work with doctors/hospitals in their panel and they share information on suspected fraudulent cases across the industry.

They also have the right to send a claimant to their own doctor for examination, sio rahisi hivyo unless you are talking about 20k.
washiku
#33 Posted : Friday, November 08, 2013 12:25:39 PM
Rank: Chief


Joined: 5/9/2007
Posts: 13,095
The mere thought that someone can even contemplate doing this is really scaring, esp after watching my friend's son in ICU for 10days, accumulated bill of 1m. That someone would wish to 'cheat' he/she was in such a circumstance is simply horrifying.
YoungMulla
#34 Posted : Friday, November 08, 2013 1:19:32 PM
Rank: Member


Joined: 3/14/2012
Posts: 577
Location: Nairobi Kenya
These friends of yours @mawinder ....
Before I die - i will touch the sky!!
dealmaker
#35 Posted : Monday, May 18, 2015 11:36:32 AM
Rank: New-farer


Joined: 3/17/2013
Posts: 24
MKWASI wrote:
mawinder wrote:
A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.




A friend of mine.. Milking the insurance dry....Honestly if one can go to such extent, he also needs to see Dr Frank just in case he is on his way to the mental hospital.

He stole from insurance companies and went missing.
http://www.nation.co.ke/...8/-/j64d4dz/-/index.html
Swenani
#36 Posted : Monday, May 18, 2015 12:09:50 PM
Rank: User


Joined: 8/15/2013
Posts: 13,237
Location: Vacuum
dealmaker wrote:
MKWASI wrote:
[quote=mawinder]A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.




A friend of mine.. Milking the insurance dry....Honestly if one can go to such extent, he also needs to see Dr Frank just in case he is on his way to the mental hospital.

He stole from insurance companies and went missing.
http://www.nation.co.ke/.../-/j64d4dz/-/index.html[/quote]

No wonder he decided to quit wazua
If Obiero did it, Who Am I?
dealmaker
#37 Posted : Monday, May 18, 2015 12:14:00 PM
Rank: New-farer


Joined: 3/17/2013
Posts: 24
Swenani wrote:
dealmaker wrote:
MKWASI wrote:
[quote=mawinder]A friend of mine with an individual medical cover is planning to look for a friendly hospital so that he is "admitted" there and the bill runs to 2.5m and once he is "discharged" the hospital refunds him 1.5m and keeps the remainder.




A friend of mine.. Milking the insurance dry....Honestly if one can go to such extent, he also needs to see Dr Frank just in case he is on his way to the mental hospital.

He stole from insurance companies and went missing.
http://www.nation.co.ke/.../-/j64d4dz/-/index.html[/quote]

No wonder he decided to quit wazua

He was seen at UpperHill Mediacal Centre today shouting.he must have been looking for Dr. Frank Njenga.
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