Insurance question

If it makes you feel any better, not submitting the claims wouldn't have helped really. They will ask what medications you've been on and everything you've been diagnosed with for the last 5 years. If you're not truthful and a question comes up after you've been covered by them, they will investigate and ask for the medical records from your doctor, who will have the information noted. If they catch you in a lie, you'll be dropped like a rock.

How would the insurance company find out if you don't give the therapist an insurance card and you pay for everything at the time of the visit? And you go to a drugstore that you don't go to for your usual meds (so when you get a printout of tax and other purposes for your main meds, the Prozac isn't on there)?

Too late for us, but I really wish we had known. Yeah, I can see her being turned down for cancer or heart disease, but Prozac? I mean, half the women I know are on antidepressants.

How would the insurance company find out if you don't give the therapist an insurance card and you pay for everything at the time of the visit? And you go to a drugstore that you don't go to for your usual meds (so when you get a printout of tax and other purposes for your main meds, the Prozac isn't on there)?

Too late for us, but I really wish we had known. Yeah, I can see her being turned down for cancer or heart disease, but Prozac? I mean, half the women I know are on antidepressants.

When your medical records are requested, the doctor turns over the entire record- so whatever he/she noted in your file is there, regardless of how you paid for the visit or which pharmacy filled your prescription. If you go through underwriting for health, life, or disability insurance, you would need to disclose medical history truthfully, providing names of all docs. Insurance companies will find out if there are errors or omissions.

When I was an agent, I had a few clients that tried to "ignore" a few rather pertinent details about their medical history. Of course it came back to bite them- fortunately for me during the underwriting process and not after the coverage was in force and a big claim was in the works. Funny fact- it was always attorneys and doctors that tried this and got caught!

When your medical records are requested, the doctor turns over the entire record- so whatever he/she noted in your file is there, regardless of how you paid for the visit or which pharmacy filled your prescription. If you go through underwriting for health, life, or disability insurance, you would need to disclose medical history truthfully, providing names of all docs. Insurance companies will find out if there are errors or omissions.

When I was an agent, I had a few clients that tried to "ignore" a few rather pertinent details about their medical history. Of course it came back to bite them- fortunately for me during the underwriting process and not after the coverage was in force and a big claim was in the works. Funny fact- it was always attorneys and doctors that tried this and got caught!

How would they find out if you omitted the doctor's name (accidentally or intentionally) or no claims were filed? They can't exactly survey every MD in the US and ask if Jane Doe was a patient of theirs.

Do docs and pharmacies have to submit info to some central clearing house by SSN so that there is some sort of universal dossier on every human being that insurance companies have access to? Is that how "they know"?

Like I said, the damage is already done at my house, but I'm just curious. If I had known antidepressants equated to uninsurable, I would have done things differently.

How would they find out if you omitted the doctor's name (accidentally or intentionally) or no claims were filed? They can't exactly survey every MD in the US and ask if Jane Doe was a patient of theirs.

Do docs and pharmacies have to submit info to some central clearing house by SSN so that there is some sort of universal dossier on every human being that insurance companies have access to? Is that how "they know"?

Like I said, the damage is already done at my house, but I'm just curious. If I had known antidepressants equated to uninsurable, I would have done things differently.

Basically, you have to answer the same general questions, which usually go "In the past x number of years have you been treated for any of the following?", then there will be a list a mile long of general issues- like heart, respiratory, mental, etc. The questions are so broad that it is damn near impossible to be truthful if you have had any issues. So if you do not answer truthfully, you run the risk of the paper trail finding you at some point. If you do answer truthfully, the underwriters either decide that your answer is all they need, OR they order med records. With life and disability insurance, physical exams and labwork will be ordered at certain coverage amounts. Also, remember that when your PCP refers you to a specialist, that specialist's report will be in your PCP's records. In this information age, we all know how little privacy we actually have-

Health insurance was NOT my favorite product. I hated telling people like you that their coverage would be extremely expensive, or non-existent. I know that Bdarg and I are probably uninsurable in the individual market for several reasons that we would consider no big deal, but underwriters quiver and shake. God forbid if we are ever not attached to an employee group.

Basically, you have to answer the same general questions, which usually go "In the past x number of years have you been treated for any of the following?", then there will be a list a mile long of general issues- like heart, respiratory, mental, etc. The questions are so broad that it is damn near impossible to be truthful if you have had any issues. So if you do not answer truthfully, you run the risk of the paper trail finding you at some point. If you do answer truthfully, the underwriters either decide that your answer is all they need, OR they order med records. With life and disability insurance, physical exams and labwork will be ordered at certain coverage amounts. Also, remember that when your PCP refers you to a specialist, that specialist's report will be in your PCP's records. In this information age, we all know how little privacy we actually have-

Health insurance was NOT my favorite product. I hated telling people like you that their coverage would be extremely expensive, or non-existent. I know that Bdarg and I are probably uninsurable in the individual market for several reasons that we would consider no big deal, but underwriters quiver and shake. God forbid if we are ever not attached to an employee group.

I hear where you're coming from. But if my doctor is my good friend and he verbally recommends Dr. Ima Therapist, he's not gonna put that in my record, so there would be no paper trail.

Or one could legitimately forget that they went to a doctor 3 years ago and had all negative results. I went to so many specialists when I was undergoing infertility treatment, I can't remember their names or find the info in my disorganized records that are scattered in the attic. Hell, I don't even remember what I had for lunch yesterday.

The truth is, they can't find things that aren't in your medical record if you don't mention them and if your doctor has no notations or specialists reports in your file unless you were insured by that company or one of it's business associates in the past when you saw the doctor in question or took the tell-tale medicine and filed a claim. Despite all the HIPAA forms you have to sign and the grief your doctor has to go through to protect your medical information, these 'business associates' agreements are wide open for interpretation and the insurance can pretty much buy your medical history (in the form of claims history)much like a bank can buy your credit history.

So, unless you pay for everything out of pocket because you know something as innocuous as a little Prozac will result in a denial (because women 15-24 are often treated with SSRI's for eating disorders and eating disorders may result in a long and intensive inpatient stay and lots of therapy and underwriters always assume the worst case scenario), you risk not getting coverage.