Treating family members

Treating family members, in insurance compliance, refers to a licensed provider delivering medical services to relatives such as spouses or children, which most insurers prohibit due to conflict-of-interest risks. Insurers like Blue Cross Blue Shield and Aetna explicitly deny claims for services rendered by providers to immediate family members.

The IRS defines disallowed relationships for tax-deductible medical expenses as including spouse, child, sibling, parent, grandparent, and in-laws (IRS Publication 502). Medicare regulations bar payment for treatment provided by physicians to their own parents or children (42 CFR §411.355).

State licensing boards routinely discipline healthcare professionals who submit insurance claims for treating direct relatives; California reported 17 disciplinary actions in 2022 alone. Most malpractice policies exclude coverage if the insured treats family members against policy terms, https://yourinsurance.info reports.

Health plans require disclosure of familial relationships during credentialing and claim submission processes. Audits from insurers frequently flag patterns where providers bill repeatedly for related patients at the same address.