Question on Obtaining Private Health Insurance

[RASAP]

While we seem to be on the subject of obtaining private health insurance, here is a question I’d like to get some feedback on from those of you that have some experience with it...

What types of “minor” conditions cause an insurance company to reject or your application or increase the premiums significantly? I understand that things like heart attacks and major cancers are cause for immediate rejection, but what about less significant things. For example, is a history of some minor skin cancers (that have subsequently been cured) something that a carrier will focus on or does it require something much more significant to get their attention?

 

[REWahoo]

What types of “minor” conditions cause an insurance company to reject or your application or increase the premiums significantly? I understand that things like heart attacks and major cancers are cause for immediate rejection, but what about less significant things. For example, is a history of some minor skin cancers (that have subsequently been cured) something that a carrier will focus on or does it require something much more significant to get their attention?

It depends on the state where you live and how serious the ins. co considers your preexisting condition. In some states the ins. company cannot reject you but can charge you an arm and a leg (or the skin off your back ) so that the premiums are unaffordable. In other states they won't increase the rate but will exclude any coverage for the particular disease (skin cancer).

You might want to look at www.healthinsuranceinfo.net to see what the rules are for your state.

 

[Martha]

...

What types of “minor” conditions cause an insurance company to reject or your application or increase the premiums significantly? I understand that things like heart attacks and major cancers are cause for immediate rejection, but what about less significant things. For example, is a history of some minor skin cancers (that have subsequently been cured) something that a carrier will focus on or does it require something much more significant to get their attention?

Insurance companies consider their underwriting guidelines a matter of trade secret. Some states have done some review of what companies typically find disqualfying but it is impossible to get any comprehensive list. Here is a link that talks about some work done in Texas to see what types of underwriting guidelines are used. It is interesting reading. http://www.opic.state.tx.us/page.php?p_sub_page_id=9 I belive California has done some research in the same area and likely other states as well.

Note that it isn't just health conditions that are reviewed in underwriting. Not fluent in English? No coverage for you!

Life insurance companies tend to be more transparent on this issue. I believe that with skin cancer, the type that is limited, has no real risk of killing you, and is not likely to reoccur will not disqualify you. What is it called? Basal cell carcinoma maybe?

 

[Dawg52]

Life insurance companies tend to be more transparent on this issue. I believe that with skin cancer, the type that is limited, has no real risk of killing you, and is not likely to reoccur will not disqualify you. What is it called? Basal cell carcinoma maybe?

Yes, that is the name. I have just become acquainted with it. BTW, glad I went a head and secured my health insurance plan early, before my retirement.

 

[Sundance Kid]

Insurance Companies can reject you, for any number of reasons. Most, you will not know about. I had a angioplasty 9 years ago, no problems since. After 90 days, my application for insurance was rejected. NO EXPLANATION. Of course, I can request to receive their decision in writing, as to their reason for their decision. I don't expect them to change their mind! : So, why bother?

We're all at the mercy of the insurance companies. Sometimes. I think it would be best, to pick a lousy weather day and just walk under a bus!

 

[Sheryl]

As an example, this site shows Washington State's 19 page questionaire, and scoring tool.

If you are over 800 points, you are put into the high risk pool.


https://www.wship.org/shq.asp

 

[Martha]

Sheryl, Washington's list is really interesting. Never heard of eye cancer. Many conditions that insurers reject out of hand in other states that I know about are not automatic rejections in Washington. But I still get 500 points for my asthma.

Before applying for individual insurance it would make sense to contact your particular state's insurance commissioner to see if the state has any information on underwriting. If not, a good independant agent may be helpful.

 

[wabmester]

I don't recall having to take the questionaire when I applied for individual coverage in WA.

You will not have to complete the Health Screen Questionnaire if you:

Have exhausted your COBRA coverage — if application is made within 90 days of exhausting COBRA coverage. (You may apply for the new plan up to 90 days before your COBRA coverage will terminate.)
Have completed 24 months of continuous coverage on an employer group health plan that has too few employees to qualify for COBRA continuation coverage.
Moved out of your existing plan's service area.
Are staying with your doctor who left your existing plan.
However, in order to be exempt from taking the health screen questionnaire your application for coverage must be made within 90 days.

linky

 

[Martha]

Wab, that is the case. Washington state is highly unusual for not requring underwriting for the HIPAA eligible and in some other circumstances. We had another thread recently about HIPAA eligibility.

 

[TromboneAl]

Of course, I can request to receive their decision in writing, as to their reason for their decision. I don't expect them to change their mind! So, why bother?

Well, there's always the chance that they'll tell you that it's because of your miscarriage, in which case you can correct them and get your insurance. That is, maybe they made a mistake.

 

[Zoocat]

I am in the process of applying for individual health insurance as my COBRA is running out in Jan. I have already been turned down by Kaiser HMO. No reason. But they have a question on their application that asks "If you have ever smoked tobacco . . ." Then you have to tell how much and for how long. I smoked long long ago during my misspent youth.

My insurance agent is telling me that my skin cancer (basel cell) will be excluded by all insurance companies.
I went through a real rigorous interview with Humana and am waiting to hear their verdict. I found that I needed to call all my doctors from past 10 years to find out the names and dates of treatments. I also obtained my medical records from my internist to make sure I wasn't overlooking something. Turns out I had forgotten dates on some minor (to me) treatments.

The situation is really awful. If you have a job with group health insurance you don't even have to apply. Contrast that with the inquisition you go through to get individual coverage.

 

[Martha]

What state are you in Oldbabe? I can't remember.

 

[Zoocat]

Colorado

 

[REWahoo]

The situation is really awful. If you have a job with group health insurance you don't even have to apply. Contrast that with the inquisition you go through to get individual coverage.

If the inquisition isn't bad enough, recognize this: you can come down with some condition requiring expensive surgery or other treatment and have the insurance approve payment only to come back after the fact and refuse to pay. "You failed to disclose you complained to Dr. Kildare in 1965 about a pain in your yet." Even though you had no memory of that doctor visit or of the complaint, they dug it up and your insurance claim for surgical removal of your yet can be denied even after being initially approved!

This sure doesn't help me sleep at night.

Oh yeah, in case you aren't sure what part of your anatomy a "yet" is, you aren't alone. It may be unique to the female anatomy because I've only seen it referred to once in an old newspaper headline: "Woman shot, bullet in her yet" <rim shot>

 

[Mr._johngalt]

I am in the process of applying for individual health insurance as my COBRA is running out in Jan. I have already been turned down by Kaiser HMO. No reason. But they have a question on their application that asks "If you have ever smoked tobacco . . ." Then you have to tell how much and for how long. I smoked long long ago during my misspent youth.

My insurance agent is telling me that my skin cancer (basel cell) will be excluded by all insurance companies.
I went through a real rigorous interview with Humana and am waiting to hear their verdict. I found that I needed to call all my doctors from past 10 years to find out the names and dates of treatments. I also obtained my medical records from my internist to make sure I wasn't overlooking something. Turns out I had forgotten dates on some minor (to me) treatments.

The situation is really awful. If you have a job with group health insurance you don't even have to apply. Contrast that with the inquisition you go through to get individual coverage.

I have endured similar, so I feel your pain. I do have a back-up plan
(advantage) which I have thought of using but have not as yet.
Since I own a corporation (PHC), it is possible to use that to my benefit
in acquiring insurance. I am not suggesting anyone start up a corp.
for this purpose, but I does add some options to your search.

JG

 

[RASAP]

Basal cell carcinoma maybe?

Yes, that's it. I guess my primary concern was that the insurance companies would focus on the work "cancer" when I told them about having had skin cancer in the past. According to my doctor, if I were asked "Have you ever had any form of cancer?" I would have to say yes. My perception is that my application would then be rejected immediately.

On the smoking thing, sure, I tried it once, and if I wanted to be brutially honest, I would have to say I smoked for about 2 weeks 40 years ago. I can just see the insurance company excluding lung cancer on my policy over that one!

 

[RASAP]

The situation is really awful. If you have a job with group health insurance you don't even have to apply. Contrast that with the inquisition you go through to get individual coverage.

Yeah, when I retire in about a year, I will be able to continue my current company provided health insurance but at quite a high cost - somewhere north of $800 / month. Based on my reading, I was under the impression I could get private insurance (DW & I) for substantially less ($600 / month?) assuming we were healthy. Guess I'm trying to understand the insurance company's position on what ailments you can have and still be considered "healthy".

 

[Mr._johngalt]

Yes, that's it. I guess my primary concern was that the insurance companies would focus on the work "cancer" when I told them about having had skin cancer in the past. According to my doctor, if I were asked "Have you ever had any form of cancer?" I would have to say yes. My perception is that my application would then be rejected immediately.

On the smoking thing, sure, I tried it once, and if I wanted to be brutially honest, I would have to say I smoked for about 2 weeks 40 years ago. I can just see the insurance company excluding lung cancer on my policy over that one!

I have filled out apps. where they asked about cancer but specifically
said "except for basil cell and squamous cell skin cancer", apparently
because it's so common. That said, I am quite sure many would reject
you out of hand if cancer of any sort appeared in your history.
Obviously, cancer insurance would no longer be an option.

An aside, I've been approved for health insurance (years ago)
which excluded so many things (based on history and lifestyle)
that I just opted to keep looking.

JG

 

[riskadverse]

I was rejected by Kaiser for "history of gall stones within the last 5 years". This diagnosis was made after one visit to the ER for continous cramps (first visit in 30 years) and a few weeks later, observations of small gallstones via ultrasound. When my Cobra nears expiration maybe I'll have them yank my gall bladder before reapplying.

 

[Mr._johngalt]

When my Cobra nears expiration

Or just get a cat. Pets are important.

JG

 

[Martha]

Good topic. What are people's experiences in working with agents to help you find an individual policy? Did you find that they have a good feel for what may cause a rejection or exclusion?

 

[Dawg52]

Good topic. What are people's experiences in working with agents to help you find an individual policy? Did you find that they have a good feel for what may cause a rejection or exclusion?

I had a liver flair up at 40(no problems since) and was on cholesterol meds when I applied. I was applying for coverage that held our company plan so may have felt they would have less exposer with my high ded(10k) over our company plan. But even so, my agent thought I had a 50/50 chance.

 

[Zoocat]

Good topic. What are people's experiences in working with agents to help you find an individual policy? Did you find that they have a good feel for what may cause a rejection or exclusion?

My agent has been very helpful. She told me upfront that almost all insurance companies would exclude the basel cell from coverage. She has also recommended certain companies and helped me to navigate the byzantine process.

 

[free4now]

I was originally rejected for BC life private insurance, but after doing an appeal that involved a couple of rounds of back and forth, and lots of keeping on top of them, I got the policy. In some sense I think it's a war of attrition. If you just keep on them and don't take no for an answer the schlub in India or wherever might eventually just get tired and approve you.

 

[Zoocat]

I was originally rejected for BC life private insurance, but after doing an appeal that involved a couple of rounds of back and forth, and lots of keeping on top of them, I got the policy. In some sense I think it's a war of attrition. If you just keep on them and don't take no for an answer the schlub in India or wherever might eventually just get tired and approve you.

I doubt that any US health insurance company would hire an underwriter from a foreign country. That would be outrageous!