Reference no: EM133347309

Someone bought a health insurance policy. This policy can never be canceled. This health insurance policy states this policy is guaranteed lifetime renewable until and unless the policyholder dies.

This policy states this policy terms and conditions cannot be altered in any way unless the President of the health insurance company formally make a change in this policy and formally sends it to the health insurance policyholder.

The policy states payment is at reasonable and customary rates. The policy has never been altered.The rate of reimbursement is reasonable and customary.

There's a ppo which pays its members next to nothing. This ppo enrolls doctors never patients. All doctors who join this ppo agree to take next to nothing reimbursements.

The health insurance company decides to alter this policy by joining a ppo.This is a breach of contract but the health insurer believes it can slip it by its old policyholders.

So then

This health insurance company identification card is now altered. The card now states that the member can go to a ppo.

The catch is that the ppo pays doctors next to nothing whereas the health insurance policy must pay the reasonable and customary rate.

This policyholder sees a doctor A. A takes this health insurance plan.

But A is a member of the ppo.

What laws and crimes and torts-be specific-are violated when the health insurer cheats reimbursing doctor A by the health insurer paying A the next to nothing ppo rate instead of reasonable and customary rate required by the policyholder's policy?

What crime has been committed through the us mails when the health insurer puts ppo on its id card so it can speciously justify underpaying doctors?