Purposely NOT claiming on insurance

Just to be clear: I do not want to lie or omit vital information on an application.

But if my insurance carrier will never give me an application, and instead base the premiums on past claims, then should I just pay for my recent doctor's visits out-of-pocket, and never even submit these claims?

Example:

Joe Smith has a COBRA policy, sees a doctor, but DOES NOT submit it as a claim. So the insurance company doesn't know about the doctor's visit. When COBRA runs out, the insurance company offers to convert to an individual policy, without asking Joe for a new application.

Jane Smith has a COBRA policy, sees a doctor, but DOES submit it as a claim. So the insurance company knows about the doctor's visit. When COBRA runs out, the insurance company offers to convert to an individual policy, without asking Jane for a new application.

My guess is that Joe has done nothing wrong, since he was under no obligation to claim his doctor's visit under COBRA, and the insurance company never asked him anything about it. My guess is further, that Jane's individual policy will have a higher premium than Joe's, since she has a history of claims.

So, my questions are:

1. How common is it for insurance companies to request a whole new application with medical history, etc on it, when converting from COBRA to an individual policy?

2. Am I right that Joe has done nothing wrong or unethical?

Thank you.

I'm going to submit the claims anyway. But I would still like to continue this discussion, and would greatly appreciate continuing this thread, if only for my own academic curiousity.

Please let me have more of your views!

Can you explain this a little to me:

Why don't you want to submit the claims? What benefit would that be to you? You're paying out the a$$ for COBRA, and then you will pay the full amount for a dr's visit to cover it up?? I guess I don't understand this.

Were the visits about a pre-existing condition or something? Will you be turning this COBRA account into an individual account within the same company??

You would not gain anything by not submitting your claims. If a co. has to underwrite you they will get the info from the MIB not from your past claims.

I can understand your reasoning. But, been through that myself when I left my long term job and lost my insurance too. Cobra in my state is about $400.00 a month! And that is with a waver and pre-existing illnesses. And I have many. When I go on Medicare, I am sure my secondary insurance will be at least $300.00 to $400.00 a month. Not looking forward to that at all.

Hello there,

The individual application wants to know about health conditions and recent treatment, not necessarily if you've filed a claim or not. So even though you haven't been running the claims through your COBRA coverage, you'll still need to include that information on your individual health application when you apply for the individual coverage.

If in the process of requesting medical records, and insurance company discovers that you didn't disclose treatment for a condition, it can be grounds to deny you a policy.

It's best to give all the information.

Good luck!

Kathy K

I wouldn't try it because it could be a small issue
and allow them to cancel you policy when you need
it most and seek payment on all past paid claims.
Very risky !They won't investigate you
until you file a claim of a significant amount
and them try everything to not pay it so don't
give them any ammunition.