How can I prevent a future health insurance co from discovering a previous dematology treatment and use it for denial of insurance?

July 20, 2009 7:45 AM

I'm an American without health insurance, who needs (minor) dermatological care... how worried should I be that this will prevent me from getting private health care insurance in a year or so (denial due to prior condition)? And what can I do to prevent this from happening?

After waiting for a year, I really need to have a few warts and dermatofibroma taken care of, maybe get a prescription or two. Nothing serious or particularly costly. I'm going to pay cash out of pocket, to a dermatologist or general practitioner whom I haven't seen before. I'm worried that this could be used against me in the next year or two when I will purchase private health insurance ... what should I do to prevent this? Is there a way the insurance company will discover this, etc... ?

Is this something I should worry about?

posted by anonymous to health & fitness (15 answers total)

I'm no expert but this kind of thing won't be used against you. I wouldn't worry at all and I wouldn't mention minor skin problems on your application. Good luck.
posted by Fairchild at 8:32 AM on July 20, 2009

I can't answer whether a minor procedure will create problems for you, but from my pre-insurance days a few years ago:

1) Always omit your Social Security number from paperwork. I really don't know how effective this is, but I suspect that it keeps you out of cursory database searches. I've always done this at all doctors and rarely had anyone ask to fill it in. If they do, you can just change one or two digits.

2) Make up a fake personality with fake info. I've never done this myself, but it would be super easy to do at a regular doctor's office as long as you're paying on the way out (cash of course to be safe). It would theoretically work at a hospital too, as my wife and I have never been carded, not even in an ER, though not only would you get your privacy but you'd get no hospital bill either.

I won't dwell on the moral or ethical considerations of leaving erroneous personal data, but given the way the insurance companies operate and the way the consumer has little recourse, health care is very adversarial in the US outside the doctor-patient relationship and I have no qualms with protecting myself.
posted by crapmatic at 8:39 AM on July 20, 2009

Even if it is not used against you (and I suspect it will from experience), if you don't put it on your application you can run into problems later. If you have a large claim they will go back and look through your file to find reasons to deny you. I have seen examples of people who have not put down "acne" on an application and had their insurance rescind their policy. All it takes is one mention of an innocent, not serious thing in your medical file to be a problem.

Because you have to give access to your records to apply they will find everything at some point. I was shocked when they were able to bring up all prescriptions, even ones I hadn't listed (because I had forgotten) and grill me about them in the interview. YMMV. As someone without insurance who's been putting off preventative care for these reasons I feel for you. Maybe I'm paranoid but i suspect I'm just a realist.
posted by Bunglegirl at 8:39 AM on July 20, 2009

The fact that you intend to pay cash out-of-pocket works in your favor. You can (and I'm not advising you to do so) simply not mention it whenever you apply for insurance. Since no insurance paperwork will be filed for the procedures, there is nothing for an insurer to datamine.

If there was insurance involved, though, it's doubtful wart removal would raise any red flags of any sort to an insurer. Mole removal might, depending on the subsequent lab results.
posted by Thorzdad at 8:42 AM on July 20, 2009

It doesn't sound like these are chronic conditions, just one-time treatable things, so I'd be surprised (though not _too_ surprised) if an insurance company cared that much.
posted by amtho at 9:10 AM on July 20, 2009

If you knowingly leave information off your insurance application, it can lead to a lot of trouble later on. They can use it as an excuse to rescind your insurance. Insurance companies investigate people who make large claims (if you have an individual policy). If for instance, a few years down the road, you need very expensive treatment (cancer, heart surgery, etc), they will investigate you and look for any excuse not to pay. If they find that you knowingly withheld this information, they can rescind your insurance AND sue you for any claims they paid on your behalf.
posted by parakeetdog at 9:15 AM on July 20, 2009

these are chronic conditions, just one-time treatable things

That's definitely true, though if OP develops a serious skin condition months or years from now, even on a different part of their body, the insuror might find this minor treatment and say "aha, it's pre-existing!"

related: Isn't the current health care reform bill supposed to do something about the pre-existing condition issue? Maybe I'm not understanding something. If that's true then OP wouldn't have to worry.
posted by crapmatic at 9:16 AM on July 20, 2009

Isn't the current health care reform bill supposed to do something about the pre-existing condition issue? Maybe I'm not understanding something. If that's true then OP wouldn't have to worry.

I've seen it mentioned but until something is actually signed I wouldn't count on it, unfortunately. And who knows if it will be retroactive? When questioned insurance head honchos said they wouldn't even stop the practice of rescission of innocent/healthy people which, to me, makes insurance almost pointless. It really puts people on individual policies on uncertain ground even when they are truthful and trying to do the right and responsible thing.

OP, if you are paying cash you are still traceable they have your SS# (also for prescriptions). I wonder if other identifying factors like your address could be a problem too. I've had doctors refuse to treat me without my SS# even if I'm paying cash so it could either be really easy or unnecessarily complicated. It might be easiest for you to just assume the best, keep everything above board and be truthful.
posted by Bunglegirl at 9:40 AM on July 20, 2009

It's worth remembering that pre-existing conditions are often subject to an exclusion period rather than not covered at all, especially if they're relatively minor. There's also generally a specific legal definition of "pre-existing condition" which is applied to insurance and which sets out the time-frame necessary for regarding a condition as pre-existing.

It's honestly not worth lying on your future insurance applications. Chances are you won't get caught, but as more and more health information is now stored and transferred electronically you can't count on that information not being accessible to an insurer down the track.
posted by Lolie at 9:47 AM on July 20, 2009

I strongly agree with crapmatic in spirit. The health insurance industry is a despicable racket. In practical terms, however, you have to protect yourself from this racket, and the best way to do that is by following the rules.

Maybe by the time you're ready to purchase insurance, legislation will have tipped the rules to favor consumers and you won't have to disclose these procedures. But until that day I'd advise full disclosure.
posted by vincele at 10:28 AM on July 20, 2009

You may be able to avoid leaving a paper trail at the doctor's office, but what about when you pick up any necessary prescriptions?
posted by availablelight at 11:08 AM on July 20, 2009

Something else to consider: what if, years down the road, you develop a health issue related to this omitted treatment or some of the prescription meds you'd taken? You'd be in a really tough spot. Do you compromise your care by not being truthful with your doctor(s)? What if you're incapacitated or unable to speak for yourself?
posted by LuckySeven~ at 12:13 PM on July 20, 2009

I was denied health insurance recently (applying as a self-employed, healthy young guy with no chronic issues) for having one sore throat 5 years prior. So yes, they may deny you insurance based on your minor issue. I did get insurance, but not my first choice plan.

Of course I could have just left the sore throat off the form when I applied.
posted by bradbane at 2:29 PM on July 20, 2009

You could always use your mother's maiden name or your middle name instead of your real last name.

I strongly agree with crapmatic in spirit. The health insurance industry is a despicable racket. In practical terms, however, you have to protect yourself from this racket, and the best way to do that is by following the rules.

Health insurance is so important and health insurance companies so despicable that I have to disagree. If following the rules is to your benefit, do so, but think long and hard before doing or saying anything that might possibly disadvantage you.
posted by kathrineg at 4:45 PM on July 20, 2009

First, try to find a sympathetic doctor. I did this with a therapist, who never really diagnosed me, but still treated me (with therapy, no medication) for the disorder. I paid with cash or card, and if asked I say it was to help resolve grieving.

Get a copy of your medical records from whoever was your last doctor, and have it signed by the doctor or clinic if possible. With your medical records in hand, you can often speak to the doctor and explain the situation, but they'll still have the knowledge they need to treat you safely and with assurance that you're not just making up stuff.

Agree to sign an arbitration waiver - it sucks, but it'll keep the doctor from worrying about a lawsuit, so they're more likely to be helpful. It often will take a few calls to find a doctor who will allow you to pay in cash under an alias, but there are sympathetic doctors out there.

Dentists and psychologists are easier though.
posted by veritas at 12:00 PM on July 22, 2009