med ins application nightmare

stargazer08

stargazer08

Recycles dryer sheets
Joined
Mar 5, 2006
Messages
194
OMG!! I am in the process of filling out apps for individual medical insurance. I'm doing BCBS at the moment and the current question I am working on is "Has any person applying for coverage ever been hospitalized or been treated in the emergency room or had any physical impairment, deformity, congenital anomaly, sickness, operation, injury or hospitalization other than admitted to above?" The previous questions asked about specific problems within the past 10 years. Now I have to go back into my childhood! That's a friggin huge arse question! Try to remember when you had your tonsils out as a kid or when you broke you arm in junior high or when you went to the immediate care center or hospital for some stitches for a cut. Not only do they want a date, they want a doctor name or hospital name. I can't remember what dr sewed up my cut hand from washing dishes when I was in 6th grade. They can't be serious about wanting all this friggin info. I will be doing Humana and United Health Care apps next. I have no idea how daunting those apps will be. I just want to drink myself into oblivion! :duh:
Rant over..
 
stargazer08,

Hey, if you can't remember the details from that long ago, what makes you think BCBS could or would try to check the info you provide? Just make it up! What is the worst that could happen?

Grumpy
 
stargazer08 said:
OMG!! I am in the process of filling out apps for individual medical insurance. I'm doing BCBS at the moment and the current question I am working on is "Has any person applying for coverage ever been hospitalized or been treated in the emergency room or had any physical impairment, deformity, congenital anomaly, sickness, operation, injury or hospitalization other than admitted to above?"
Click to expand...

Kind of makes you feel like they're setting you up to deny payment for future claims because you forgot to report that zit you had when you were 17 years old, right?

I don't think most carriers would take it to that extreme but it does leave you with an uneasy feeling about whether they'll be there for you if the going gets rough.

We need a better system which doesn't penalize patients who have been sick for getting sick again.
 
To bad your not in my shoes! The hospital that I was born in, and treated at for various and sundry things as a kid....is GONE! Out of business, and torn down! Has been for about 30 years. The doctors and dentists that I saw when younger.....DEAD! No offices...No records! They contacted us before they closed up shop, and said if we wanted the records, to come down and get them....we didn't. There wasn't anything earth shaking in my med history...chicken pox, measles, swallowed chick bone, etc. No biggies.

So, when it comes to filling out med history for insurance companies, etc....I can go all the way back to.....hmmmm, about 12 years ago. If they want records before that, they're SOL! :rolleyes:
 
Goonie said:
To bad your not in my shoes! The hospital that I was born in, and treated at for various and sundry things as a kid....is GONE!
Click to expand...
Contrast that with a co-worker of mine. She just had her baby delivered by the same doctor that delivered her more than a couple decades ago. This in a major hospital in a major US city.

Anyways, just fill out the forms like you fill out your tax return: put question marks everywhere??
 
That article pretty much states my fears about filling out this app. I didn't complete it because I knew I needed to think this one over. Neither Humana nor United Health care asked that specific question. My DH and I are healthy and in our mid forties and obtaining individual ins shouldn't be a problem. We're applying for HSA ins with 10G ded so I would think any minor problems we have would not impact their bottom line...just ours. No wonder our regular ins agent hasn't been very attentive about helping us apply for BCBS. If I wasn't so burned out from my job I would just recind my letter of resignation.
 
They don't care about the small stuff. It's the big things they are worried about such as congenital problems, heart surgeries, etc..any kind of serious illnesses, etc. Come on guys, they aren't going to deny you coverage cuz of the zit you had as a teenager or even the strep throat. The carriers aren't worried about small risks. Think like a business...If someone came to you and said, "I'd like you to be on the hook for 5 million dollars in case I get sick, but I only want to pay $200/mo for that", wouldn't you want to know a little bit about the risk coming down the pipeline? I always tell my customers not to really worry about every little sore throat or routine office visits. It's the major surgeries, chronic illnesses, etc...that you want to disclose.

The guy with the "angina" in the article was a questionable case, having had a major heart attack just a few years after obtaining coverage. I guarantee you the investigative reports did not give you all of the details. If heart attack risk had really been ruled out, and that was clearly stated in the medical records, the division of insurance would force the insurance carrier to pay.
 
I loved the fine print in the kaiser individual coverage I had before I got married.

Basically said if any information was found to be incorrect or misrepresented, that they could not only cancel you and refuse to cover stuff, but that you'd have to pay them back for ALL costs and procedures they'd expended in prior coverage back to the first day you were insured.

Nothing about them refunding all of your premiums though...
 
Yeah, when they mention recinding coverage I wonder if they give back any premiums you have paid. As for dates, that's a concern of mine. I really don't remember exact dates. I have called my dr to obtain some dates but for others...especially the question I posted about...it's a best guess on my part. Plus, do they really want (or need) to know I had a tubal ligation? It is a surgery but I had it done 20 years ago! This entire process is nutty. BCBS is my prefered provider but the final question has me questioning whether it would turn into a nightmare if I ever had a major claim. I know I'm probably over thinking this entire health insurance thing but with the BCBS app I think my concerns are justified.
 
stargazer08 said:
Yeah, when they mention recinding coverage I wonder if they give back any premiums you have paid. As for dates, that's a concern of mine. I really don't remember exact dates. I have called my dr to obtain some dates but for others...especially the question I posted about...it's a best guess on my part. Plus, do they really want (or need) to know I had a tubal ligation? It is a surgery but I had it done 20 years ago! This entire process is nutty. BCBS is my prefered provider but the final question has me questioning whether it would turn into a nightmare if I ever had a major claim. I know I'm probably over thinking this entire health insurance thing but with the BCBS app I think my concerns are justified.
Click to expand...

When they rescind coverage, they DO pay you back all of your premiums back to the date that you originally started. It is a very rare occurrance, and typically only happens if there was blatant fraudulent failure to disclose something on the application. It happened ONCE (in the past 10 years) to one of our clients who purposefully failed to disclose something. That person happened to be a lawyer (can you believe that?!). When confronted, she did admit that she has failed to disclose the illness on her application on purpose.

The tubal ligation is not going to affect your ability to get coverage. You might as well disclose it, since you do remember it, and as far as dates, just give the date to the best of your ability. At the end of the BCBS application, there is a place to write comments. If it makes you feel better, you can make a statement that you tried to remember dates to the best of your ability, but they may not all be 100% correct. If there isn't such a place to put comments, just fill out a blank sheet of paper with a statement and then sign it and add it to your contract. They'll keep it on file as part of your contract, and you should always keep a copy too.
 
MKLD, thanks for your input and help both on this forum and in PMs. I know DH and I are probably over thinking this subject but it has such a great impact on our ER plans. I hope we can get these apps filled out and submitted by May 31st. That's my goal. I truly hate filling out forms so this has been a real challege for me.
 
"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.
 
mykidslovedogs said:
They don't care about the small stuff. It's the big things they are worried about such as congenital problems, heart surgeries, etc..any kind of serious illnesses, etc. Come on guys, they aren't going to deny you coverage cuz of the zit you had as a teenager or even the strep throat. The carriers aren't worried about small risks. Think like a business...If someone came to you and said, "I'd like you to be on the hook for 5 million dollars in case I get sick, but I only want to pay $200/mo for that", wouldn't you want to know a little bit about the risk coming down the pipeline? I always tell my customers not to really worry about every little sore throat or routine office visits. It's the major surgeries, chronic illnesses, etc...that you want to disclose.

The guy with the "angina" in the article was a questionable case, having had a major heart attack just a few years after obtaining coverage. I guarantee you the investigative reports did not give you all of the details. If heart attack risk had really been ruled out, and that was clearly stated in the medical records, the division of insurance would force the insurance carrier to pay.
Click to expand...

Not sure I understand why the guy with the angina would not be covered if the heart attack occurred a few years after obtaining coverage. If most of these policies have a 12 month pre-existing condition exclusion (and assuming his did as well), then shouldn't he be covered if the heart attack occurred more than 12 months from the start of his policy regardless of pre-existing condition? Or did he neglect to report the angina on his application?

With regard to actually obtaining individual coverage, what types of things does a relatively healthy person have to worry about? If someone who has never had a major disease or injury is overweight, does that translate to not being able to obtain coverage? What about this example.....10 years ago someone went to the ER with some chest pain. Blood tests, EKG, stress test, etc. all normal. No further issues. Will something like this cause someone to be denied coverage or result in an exclusion?
 
mykidslovedogs said:
They don't care about the small stuff. It's the big things they are worried about such as congenital problems, heart surgeries, etc..any kind of serious illnesses, etc. Come on guys, they aren't going to deny you coverage cuz of the zit you had as a teenager or even the strep throat. The carriers aren't worried about small risks. Think like a business...If someone came to you and said, "I'd like you to be on the hook for 5 million dollars in case I get sick, but I only want to pay $200/mo for that", wouldn't you want to know a little bit about the risk coming down the pipeline? I always tell my customers not to really worry about every little sore throat or routine office visits. It's the major surgeries, chronic illnesses, etc...that you want to disclose.
Click to expand...

I have received similar advice from health insurance brokers when I was filling out the applications. The question I have is what constitutes big versus small and what might get me into trouble down the road vs. what won't if I leave the information off the application. I am very fortunate in that I don't yet have a whole lot of medical issues worth mentioning, so it's not really that hard to put everything that the insurers would care about plus some stuff they probably don't on the app. But it would be really nice if there were a bright line standard. I think I have seen some policy applications that limit their inquiries to the last 7 years or something.

2Cor521
 
Humana and United Health Care only ask about the past 10 years. Only BCBS had the last open ended question. Just got off the phone with them. I told them I couldn't remember all the times I made visits to the ER when I was a kid. Plus, I had my tonsils out when I was 28 but for the life of me I can't remember the doctors name or the facilility I had it done at! The only response was "fill it out to the best of your ability". I plan on doing that and let the chips fall where they may. I'll finish all apps tonight and see what happens. This is basically for a self funded plan. 10G ded HSA. We're healthy and prefer to spend our healthcare dollars wisely.
 
stargazer08 said:
Humana and United Health Care only ask about the past 10 years. Only BCBS had the last open ended question. Just got off the phone with them. I told them I couldn't remember all the times I made visits to the ER when I was a kid. Plus, I had my tonsils out when I was 28 but for the life of me I can't remember the doctors name or the facilility I had it done at! The only response was "fill it out to the best of your ability". I plan on doing that and let the chips fall where they may. I'll finish all apps tonight and see what happens. This is basically for a self funded plan. 10G ded HSA. We're healthy and prefer to spend our healthcare dollars wisely.
Click to expand...
I just applied for BCBS IL policy for DW. They ask about last 10 years too, not a from ' day you were born ' request for info. Could it be that it is different for the different states?
 
eridanus said:
"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.
Click to expand...

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.
 
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?
 
RASAP said:
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?
Click to expand...

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.
 
mykidslovedogs said:
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.
Click to expand...

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?
 
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...
 
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