health history for health insurance

V

vic

Recycles dryer sheets
Joined
Oct 14, 2003
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175
My husband had cancer about 7 years ago. He had chemo and surgery and has been cancer free since then.

Hopefully he will also kiss the cube job goodbye soon. Does he have to dislose every detail of his health history when he applies for health insurance elsewhere or can this be held against him? Is there a time limit when certain things are not reported no more or can not be taken into account no more? It was never claimed on his insurance since he paid out of pocket for all of it. Does anybody have any experience with this?

Also, is there the equivalent of a credit report that can be requested by the consumer to see what has all been reported in the health/insurance history?

Vicky
 
Look at this post for checking the MIB:
http://early-retirement.org/forums/index.php?topic=234.0

A health insurance company underwriter can go back as far as they want, to my knowledge. They have ways of ferreting out info. And they may ask you for more info as part of the underwriting process. They asked me about a condition one of my kids had, which was cured years before, and was no real big deal anyway. But I had to get that Doc's to send them a report. And then the underwriters disallowed any claims against that condition for two years.

I have heard instances in the last couple years of insurance companies not paying out for a later problem, saying that the customer violated the agreement by not disclosing a previous condition, even if it was years before.

IIRC, cancer and heart disease are usually the biggest underwriting red lights there are.
 
The MIB report is included in the FACT Act. You can now get one free annually.
 
Telly said:
Look at this post for checking the MIB:
http://early-retirement.org/forums/index.php?topic=234.0


I have heard instances in the last couple years of insurance companies not paying out for a later problem, saying that the customer violated the agreement by not disclosing a previous condition, even if it was years before.
Click to expand...

If you have a big claim, you can absolutely count on this (back fact
checking). Better to be absolutely honest on the app. otherwise
you could wind up paying premiums for nothing.

JG
 
Mr._johngalt said:
If you have a big claim, you can absolutely count on this (back fact
checking). Better to be absolutely honest on the app. otherwise
you could wind up paying premiums for nothing.
Click to expand...

What he said. I just went through the application process and they wanted to know about every medical condition I experienced in the last ten years. Although I disclosed everything, when I submitted my first (small!) claim, they asked me to sign release forms so they could obtain all my medical records to make sure it wasn't a preexisting condition. This was strange to me. The application had authorized them to access those records, so I figured that they had read the records before issuing the policy in the first place...

The moral: Tell them everything 'cause they will find out anyway. And just because you have a policy it does not necessarily mean that you have coverage, if there is any chance they might find a preexisting condition that you didn't disclose.
 
In California, it's 10 years. And this even includes anything discussed with a doctor or other health prof. , even if no treatment was done!

MIB will have info on you if you had or applied for individual health insur, but may not have your info from a group plan.

You may be forced into a state run high risk pool.

If you have any way of converting a group plan , that is usually the best way to go.
 
I think the answer depends on your state laws. In Washington, if I convert directly to an individual policy after exhausting my COBRA coverage, I do not have to fill out the health screening questionaire.

If I wait until more than 63 days have passed and then try to get individual insurance, I will be required to fill it out, and then I will be rejected and thrown into an expensive state risk pool with lousy coverage.
 
Disclose fully and honestly any information which is requested.

The only thing worse than not having health insurance is having it, paying for it then having major claims denied because of failure to disclose upon application.
 
Rich_in_Tampa said:
Disclose fully and honestly any information which is requested.

The only thing worse than not having health insurance is having it, paying for it then having major claims denied because of failure to disclose upon application.
Click to expand...

I 100% agree with that statement, having seen the denial of a $350,000 claim due to lying on the app.................. :-[ :-[
 
I suggest when looking for insurance that you work with an agent. The agent can be helpful in determining whether to even apply on the open market.

Your husband will have rights under federal law (HIPAA) when moving from his group plan to an individual plan. How your state addresses HIPAA rights can be found in the Georgetown guides at www.healthinsuranceinfo.net. Sheryl gave the example of Washington state. In that state when you move from a group plan to an individual plan there will be no need to fill out a health questionaire. Other states offer risk pools. These pools vary in what they cost and what they cover. In yet other states you might have the right to a conversion policy. Unfortunately, these are often expensive and don't provide as good coverage as a group plan.

There are missing states on the Georgetown site. If your state is missing, let us know, there are other resources for finding information on your state, such as the state insurance commissioner.

Good luck!
 
Martha said:
Sheryl gave the example of Washington state. In that state when you move from a group plan to an individual plan there will be no need to fill out a health questionaire.

Good luck!
Click to expand...

Yes, But.

Of course it's much more complicated than that. There are restrictions on who can do this - how long you have had previous coverage, did you use up COBRA first, on and on and on. The more I read the more confused I am. All I know for sure is I have a lot more research to do.

I will be using our state's Help Line to get some questions answered first, then start talking to agents. (Thanks for that suggestion Martha) I wasn't sure if an agent would be a good idea or just a salesperson for their own products. I'm going to ask around for referrals before talking to anyone.

Health Insurance is certainly the hardest part of ER. Makes saving up a couple million bucks seem easy by comparison. :-\
 
Sheryl said:
Health Insurance is certainly the hardest part of ER. Makes saving up a couple million bucks seem easy by comparison. :-\
Click to expand...

That's been my experience.

JG
 
Sheryl is absolutely right; there are lots of steps to go through to figure out what you can get.

I mentioned HIPAA giving some rights when moving from group plans. These are the HIPAA eligibility rules:

No matter where you live in the U.S., if you are federally eligible you are guaranteed the right to buy individual coverage of some kind with no pre-existing condition exclusion periods. To be federally eligible, you must meet all of the following:

´ You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.

´ You also must have used up any COBRA or state continuation coverage for which you were eligible.

´ You must not be eligible for Medicare, Medicaid, or a group health plan.

´ You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be federally eligible.)

´ You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.

Federal eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become federally eligible again by maintaining continuous coverage and rejoining a group health plan.


The problem with HIPAA guarantees is that there is no rate regulation by the federal governmentand different states have different ways that they comply with HIPAA.
 
I am in the process of applying for individual health insurance as my COBRA is ending in Jan. What I've found helpful is to work with a health insurance agent and to get my medical records from my primary physician for the past 10 years. Filling out the application was much too difficult, actually impossible, without the records to refer to. I had forgotten some things, luckily minor things to me. But who knows what the insurance company will think. :-\

I had never heard of the MIB. Thanks Martha!
 
Oldbabe said:
I am in the process of applying for individual health insurance as my COBRA is ending in Jan. What I've found helpful is to work with a health insurance agent and to get my medical records from my primary physician for the past 10 years. Filling out the application was much too difficult, actually impossible, without the records to refer to. I had forgotten some things, luckily minor things to me. But who knows what the insurance company will think. :-\

I had never heard of the MIB. Thanks Martha!
Click to expand...

I am looking toward switching insurance again (hopefully last time until
Medicare kicks in). Over the past 10 years, I've seen at least 12 doctors in 3 states (lots of tests, etc.). It's a very long list and it would even give me pause if I was
presented it along with an app. for new coverage. OTOH, recently
my "doctoring" has reduced, so maybe that will help.

JG
 
I checked the website for MIB to get my 'health insurance credit check'. According to the site I probably do not have a health insurance record like 80% of the population since I have not applied for individual insurance yet. Mmmm, my health history is not available to me until I have applied at least one time for insurance.

Even I have a record, the FAQ states that all MIB codes are purged after 7 years. Would that mean that there is no traceable record unless you remember all of that yourself (I can't even remember when I broke my little toe during karate)?

I just do not think it is fair that a health history blip a long time ago can disqualify people. In car insurance etc, it all falls off the record some time.

The TX high risk pool rates were not as bad as I expected. With a $5000 deductible, it is $278 for a 40 yr old to $556 for a 65 yr old non-smoker.

Vicky
 
Some people specifically don't apply for individual insurance when they have health problems just because they don't want the denial and information on their record.

Even if information in not on the MIB record, it likely is in your medical provider's file. When you apply for health insurance generally you consent to the review of all your medical files by the insurance company. So, they will have access to those files.

Say you get a serious disease like cancer. The insurance company at that time may choose to do a review of your past records to see if you in fact disclosed everything you were supposed to disclose when you applied for individual insurance. If you didn't, they may very well deny your claim and cancel your policy. Even if what you failed to disclose has nothing to do with your current illness.

Federal law provides that an insurance company can cancel your policy for fraud, defined as "the individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage."

I have read articles lately about an increasing trend by insurance companies to try to cancel policies for failure to disclose information--they are really pushing the limits on the issue.
 
Martha what kinds of things are they finding that people didn't disclose? For example, when I was 17 I had mono but it's something I always forget to put on my information at the doctors office so I figure I'll probably forget it if I ever have to apply for individual insurance. Now if years later I have liver problems could they come back and say it was because of the mono that I forgot to put on my application and hence cancel me or deny payment?
 
vic said:
I just do not think it is fair that a health history blip a long time ago can disqualify people. In car insurance etc, it all falls off the record some time.

The TX high risk pool rates were not as bad as I expected. With a $5000 deductible, it is $278 for a 40 yr old to $556 for a 65 yr old non-smoker.

Vicky
Click to expand...

We just put DW into the TX high risk pool. You are correct, it is pricey but not exorbitant, and a real advantage is all they ask for is a 6 month history of what you've been treated for. There are no disclosure requirements beyond that and no waiting periods or exclusions since we are coming directly off COBRA.

Nice to know there isn't an accidental "gotcha" lurking somewhere in her future because she forgot about something on her application.
 
Martha said:
Even if information in not on the MIB record, it likely is in your medical provider's file. When you apply for health insurance generally you consent to the review of all your medical files by the insurance company. So, they will have access to those files.
Click to expand...

I once had a patient who revealed cocaine use in her medical history; it was medically relevant in her care. A couple years later she applied for life insurance and sent me a release which explicitly included releases for substance use, mental illness, etc. I complied with her request.

She then had the policy denied due to the history of cocaine use. She became irate with me and threatened to sue me. Fortunately, I kept my cool, told her that not only did I not do wrong by releasing this, but in fact I was obliged to release it upon her explicit request.

Long story short, she went away. This whole area has caused me a lot of gray hairs over the years.
 
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