med ins application nightmare

[mykidslovedogs]

Originally Posted by eridanus

"Yenny Shu of Los Angeles, for instance, contends her coverage was canceled after she was diagnosed with breast cancer at 46. In its letter rescinding her coverage, Blue Cross allegedly told her that she failed to disclose her exposure as a child to the Hepatitis B virus."

It's no wonder California BCBS settled the lawsuit.

I would HOPE they would settle that case. That, IMO, would be an obvious mis-statement vs. blatant fraudulent failure to disclose. Every state has a statute of limitations on mis-statements (usually, it's around 2 years - if nothing happens by then, the insurance company can't legally go back and rescind with a mis-statement.) As a broker, I would immediately take a case like that to the division of insurance and have it settled right away by an unbiased third party.

[RASAP]

So here's what I'm wondering...

You fill out your application, accept the insurance policy offered, and pay premiums for the next 3 years making little or no claims during that time. Then, stuff happens and you have to have heart surgery. Does the insurance company start comparing your application to your medical history (in hopes of denying the claim) at that time or do they look for inconsistencies during the first 3 years?

[mykidslovedogs]

Originally Posted by RASAP

So here's what I'm wondering...

You fill out your application, accept the insurance policy offered, and pay premiums for the next 3 years making little or no claims during that time. Then, stuff happens and you have to have heart surgery. Does the insurance company start comparing your application to your medical history (in hopes of denying the claim) at that time or do they look for inconsistencies during the first 3 years?

There's no doubt that something like that could happen. Best thing to do is, if you are unsure about what's in your med records, just order them and submit them with your application. That way, once your accepted, it's done. They won't have any need to get med records, because they will already have them. Five years worth is usually enough. Do the best to disclose everything you can remember as far back as they ask you to.

Don't overthink it. There is a statute of limitations on mis-statements - if you forgot about something that happened in your childhood and failed to disclose it, and didn't have any claims for several years, and you didn't purposefully fail to disclose it, they can't rescind unless they can prove that purposefully left it off the application. Obviously, if it was something that happened when you were 2 and there is no way you could have remembered it, they are not going to be able to prove fraud.

The only time they can rescind after a couple of years is for fraudulent failure to disclose something. Look, most people remember the major things that happened in their lives. Most applications don't even ask you to go back more than 5 or 10 years. Apparently, Blue Cross has a question about "have you ever", but most carriers don't look back that far.

[MileKing]

Originally Posted by mykidslovedogs

Best thing to do is, if you are unsure about what's in your med records, just order them and submit them with your application.

If it were only as easy as ordering a pizza, no one would have any problems. Over the past 20 years, I think I've lived in 4 states (6 different cities) and have had a handful of different primary care doctors, all but the most recent that I can even remember. Through in a few trips to urgent care centers (where, when, and for what, I don't recall) and 2 ER visits and the task of collecting one's records becomes daunting, if not impossible. And I'm certain that there are many people who have seen many more doctors and visited the hospital many more times than I have.

I've heard MIB mentioned, but my understanding is that MIB will only have information on you if you were covered by an individual insurance policy (not insurance through an employer, which is my case since I've been working). So how does one go about assembling one's medical records? How long do doctors and hospitals typically keep such records? When one says "records", what is included? Old x-rays? My new patient questionnaire? And finally, if such records are not available to me (doctor retired, hospital gone, records destroyed, etc.), how will the insurance company be able to get them to deny a claim?

[cute fuzzy bunny]

Its called "data aggregation". If any of the prior procedures, prescriptions or doctor visits were submitted to the insurance company, they may have consolidated that information and maintain it...even if you cant find it or get it.

I couldnt for the life of me tell you who my insurer was in my 20's, other than that I had one...

[kramer]

I recently applied for and got an Aetna HSA policy. They went back 10 years like most of the insurers mentioned here. No "have you ever" type questions except that they did want to know if you had ever filed a workmen's comp claim, I think.

Based on my health insurance application experience, I will always maintain up to date health records and keep them in my possession. When I switch doctors or move, I will proactively order the medical records of my old doctors. My medical history was pretty simple, but there was no way I could have accurately filled it out without the records.

Better to think of medical records like 1099s and W-2s, except that you only get them when you ask for them.

I am scanning in my records for archival purposes, also. Although I consider the paper copies the most important.

Kramer