pre-existing condition and insurance Posted: 07-13-08 20:40pm
Hello everyone,
I have a question and should start this
off by telling you my small story.. I am
a 29 yr old male and went to a family
doctor for a check up. Turns out I have
an external hemorrhoid. I have not seen
any other doctor besides this doctor.
My question is:
If I buy health insurance, would they be
able to find out about this pre-existing
condition? If they wont be able to find
out, what kind of insurance should I get?
I have no idea what kind of insurance
would cover a hemorrhoidectomy so any help
will be greatful.
Thank you
|
katherinek74
New User, Becoming EHEALTHy
Joined: 13 Jul 2008 Posts: 5
Pre-existing condition and insurance question Posted: 07-13-08 20:58pm
Hello there,
All health insurance applications will ask
you if you've seen a physician for a
condition that will require surgery or
further follow up. You would need to
answer that question truthfully "yes" at
this point, and unfortunately that would
make you ineligible for coverage for that
issue.
There are certain conditions that health
insurance companies will treat as a
pre-exisiting condition: Meaning they'll
approve the policy but will not allow you
to have coverage for that condition for a
pre-determined period.
And then there are conditions that health
insurance companies will treat as serious
enough that they are not able to approve
coverage until the issue is resolved.
General rule of thumb is that any time you
have need for a surgical procedure, they
health insurance companies will see you as
a bad risk, and will not approve you until
you've had that taken care of.
The best thing to do would be to contact a
health insurance agent/broker in your area
who would be most familiar with insurance
underwriting guidelines and can give you
guidance on whether or not it's worth your
time to apply for the health insurance at
all. They can call insurance companies
and give them the general scenario and get
a likely determination over the phone, so
you won't waste your time filling out an 8
page applicaiton only to get declined.
Good luck!
Kathy K
|
painpainpain
New User, Becoming EHEALTHy
Joined: 01 Jun 2008 Posts: 5
Posted: 07-13-08 21:32pm
Hey thanks for the info.
My fiance is a nurse and told me that
since I copayed at a family doctor, that
it would be illegal for health care
insurance compaines to obtain that
information. Is this true? She said that
once I got health care insurance, I would
go to a new family doctor, fill out all
the forms and play it off like this is a
new problem. Does this sound correct?
Can health insurance compaines still
obtain those medical records? I live in
PA if that helps at all.
Thanks for your quick reply!
|
painpainpain
New User, Becoming EHEALTHy
Joined: 01 Jun 2008 Posts: 5
Posted: 07-13-08 21:52pm
I am so sorry, I realized that I left out
a lot of important information in the
first post. I am going to re-edit it.
Been a long day *sigh*
*edit* ok it won't let me edit my post so
I am going to re-ask my question again and
explain my situation a bit better.
I am a male, 29 years of age. I do NOT
have health insurance. I recently found a
lump on my bottom and went to a family
doctor to get it looked at. I went to the
family doctor WITHOUT insurance and payed
WITHOUT health insurance, a copay of $75
dollars for the visit.
Now I am pretty sure that the family
doctor I went to uses computers to store
their information and peoples medical
records and so fourth. They perscribed me
some medicine, but never called up the
pharmacy, but instead gave me a
perscription to bring to the pharmacy.
Now knowing that I did not have insurance,
if I where to try and apply for health
insurance, would a health insurance
company be able to obtain those medical
records from the family doctor or would it
be illegal?
Would they be able to get information from
the pharmacy as well?
I will be honest in saying I am completely
new to all of this. Would it be a bad
idea to apply for health insurance and see
if they grant me the health insurance or
not by beind dishonest about my
pre-existing condition?
Like I said, it has been a long day so
sorry about my mistake in leaving out
important information, like me not having
insurance and so on.
Still not sure if an insurance company
would even be able to find out that I had
this check up since I had no insurance. I
mean, ofcourse these days things are done
electronically, but it's not like there is
a national database showing everyones
medical records. I can't understand how
in the world they would find out I had
this checkup...
|
katherinek74
New User, Becoming EHEALTHy
Joined: 13 Jul 2008 Posts: 5
Privacy vs. Disclosure Posted: 07-14-08 05:27am
Hi there,
When you fill out an application, you are
legally obligated to fully disclose all
information requested and answer the
question's truthfully. THere tend to be
questions on applications about whether or
not you've got any outstanding medical
issues that they'll need to know about.
You would truthfully answer that you were
diagnosed with an external hemroid, and
then they'll want to know the name of that
physician. They will request medical
records most likely. It's not a matter of
whether it's legal or not for the health
plan to obtain that information. It's
more about you being required to legally
disclose all known information about your
health condition.
If you were to not put that information on
the application, and then say 4 months
after you get coverage go to a doctor and
have surgery, and the health insurance
company discovers that this was something
that you could have intentionally not
disclosed on your application, that could
be a much larger problem, where they could
investigate all of your medical history to
determine if you intentionally left
information off.
You are correct however, that if you paid
cash for the appointment, and a claim was
not being filed with any health insurance
company there would be way other than
yourself that they would find that
information.
|
Jethro66
New User, Becoming EHEALTHy
Joined: 03 Aug 2008 Posts: 4
pre-existing condition and insurance Posted: 08-03-08 20:13pm
Well when I signed up for my policy I had
to give them complete access to my health
records . You can try to deceive them but
they have a thing called post-claim
underwriting in which even after they
have paid a claim they can retroactively
seek back all paid claims if they some how
find out about your deception. I
wouldn't want that hanging over my head
.You could end up in a bad way
financially.This has happened to people a
year after they received treatment.
They were paying big bonuses to employees
who dug up stuff people left
out of their application.
|
nightangel73
Extremely EHEALTHy
Joined: 09 Nov 2005 Posts: 2486 Location: ,
Thanks: 14
Thanked:10
Posted: 08-03-08 21:36pm
painpainpain
wrote:
Hey thanks for the info.
My fiance is a nurse and told me that
since I copayed at a family doctor, that
it would be illegal for health care
insurance compaines to obtain that
information. Is this true? She said that
once I got health care insurance, I would
go to a new family doctor, fill out all
the forms and play it off like this is a
new problem. Does this sound correct?
Can health insurance compaines still
obtain those medical records? I live in
PA if that helps at all.
Thanks for your quick
reply!
This sound like the smart thing to do. I
would not tell anything about the
hemorroid, not mention that doctor. Please
an external hemorroid? That is no big deal
at all. Millions of people have
hemorroids, in fact I myself have an
internal one and most likely will develop
a number of external ones during my
pregnancy now. Did the doctor said you
will need a surgery? My best friend got
treated for external hemorroid and all the
doctor did was inject it with some
medication and voila. I knew of a lady who
did had hemorroid surgery but she really
had a real bad case. Not one but several
hemorroids and she had surgery like after
20 years of suffering of the hemorroids.
