Health Insurance Application Spin?

January 18, 2006 7:31 PM

Do I have to represent myself with a flawlessly healthful past to be approved for individual (Blue Cross) health insurance?

I'm not talking about fraud here; I'm just wondering what the standards are on truth vs. spin. I don't have any major illnesses or conditions to cover up, but I've always heard that when filling out a health history you're expected, (even by doctors and insurance brokers) to obfuscate a bit, and if you mention a medical issue, it's assumed to be much, much worse and you get blackballed. The form is asking for every detail of every single medical issue I've encountered in the last DECADE. Do I pretend I haven't had "sign or symtoms" of anxiety, acne, dizziness, infections or athlete's foot since 1995? If I say I have a glass of wine with dinner do they assume I'm a drunk? And if I omit anything, will they catch me by checking my doctor's records, specifically on prescriptions? I'd prefer to be completely honest, but if I get turned down I may just move to Canada, or someplace with a sane health system.

posted by anonymous to health & fitness (14 comments total)

FWIW, I have this insurance and I reported an old knee problem and chronic ear infections and still got insurance. However, mine is more catastrophe insurance untill I find a job with decent health care and I move onto their's
posted by jmd82 at 7:59 PM on January 18, 2006

if you have no problems that would preclude coverage, be honest. if you do, be honest, because they won't cover any claims if you're found out, and they will likely find it. this is more for cancer patients that have a relapse and then default on a million dollars of bills that should have never been covered in the first place.

welcome to the US.
posted by kcm at 8:45 PM on January 18, 2006

Watch out about reporting acute problems in a way that they can misread (whether accidentally or willfully) as chronic problems. For example, I was once initially denied health coverage about 10 years ago because I (truthfully) put down that I had bronchitis (meaning I had had it once) and sciatica (mildly, from time to time). Well, turns out they read that as chronic bronchitis and chronic nerve damage, and they were going to deny me as too high a risk for the pool. It took seveal letters from my doctor to convince them that I wasn't about to drop dead.
posted by scody at 9:58 PM on January 18, 2006

I've heard of patients being denied individual coverage for acne, asthma, and shoulder injuries from minor car accidents. And this is not hyperbole.
posted by gramcracker at 10:20 PM on January 18, 2006

it's useless hyperbole until you prove those statements, and that's coming from a *strong* dissenter in the state of US healthcare.
posted by kcm at 10:26 PM on January 18, 2006

I recently had to apply in Washington State for private Regence/Blue Shield policies for myself and my three kids. (My disabled husband went on Medicare and the rest of us had to fend for ourselves.) I had to complete a lengthy application for each of us. They assign various points to specific diagnoses, and, in our case, our eldest daughter scored too many points and was denied coverage until, like scody, we had to get letters from the treating physician--who verified her mild tachycardia symptoms as stress-related---well, duh, her father had just been horrifically injured!---and not a sign of heart disease. I do remember the questionnaires being very specific: only mark down conditions for which you have been diagnosed by a physican. So, sad tale is this: bottle up all your aches and pains until AFTER you have your new insurance. Seems ass-backwards, doesn't it?
posted by DawnSimulator at 11:18 PM on January 18, 2006

Find yourself a good agent. A good agent will be your ally and advocate to not only get you the best rates, but run interference for you when it comes to dealing with this type of thing. If the insurer is worth its salt, it will conduct a clinical investigation, examining your medical records within a certain timeframe, to determine your premiums. If the insurer has a record of flat out denying people with chronic or pre-existing conditions, you probably don't have a chance. But again, that's where an agent comes in. He or she can help you with these problems.
posted by FergieBelle at 5:38 AM on January 19, 2006

Last year when I tried to apply to BCBS, I noted on the application that I had been diagnosed with Type 2 diabetes in the past. Now I control it with my diet and have no health related issues because of it. But they turned me down. So I say screw them, the premiums are more than enough to deal with any ailment unless it is a severe condition requiring lots of care.

On a side note, afterwards I moved to Spain for several months where I was required to get insurance there. The application process for Sanitas didn't even ask and the premiums were only $30/month. I used the doctor there when I had knee problems and the care was exceptional as was any dealing with the insurance company.
posted by JJ86 at 6:05 AM on January 19, 2006

When I filled out my forms for getting insurance at my current job, all I had to tell them was whether I had any chronic conditions for which I had received or was in the process of receiving treatment.
posted by elisabeth r at 6:29 AM on January 19, 2006

I applied for, and received, Blue Cross coverage just a few months ago and I found the decade history requirement (with names, addresses, treatment details, and dates!) absurdly onerous, especially since I was applying for a household of four. Since I don't keep a dated record of every single visit to a medical practitioner for every cough, sniffle, and aching back, I called and asked how to best deal with this section of the application. They told me "just fill in what you can, get the dates approximately right, we're primarily concerned that you're in good health at the time of application."

I gave them an approximate three year history to the best of my recall. It's likely I omitted some things in good faith, but it didn't seem to be a problem. They went above my quoted rate due to the history I reported, but all four applications were approved.

"When I filled out my forms for getting insurance at my current job,"

That's not individual coverage, that's group coverage. Group coverage is a hell of a lot easier to apply for. My experience with group coverage a few years back was nearly identical to your own. Unfortunately, your experience isn't relevant to the question.
posted by majick at 7:37 AM on January 19, 2006

My husband and I applied for coverage for Blue Cross of California about a year and a half ago. Amazingly, they rejected us because of a pre-existing condition I have, a hereditary red blood cell disorder. I say "amazingly" because the condition does not currently require me to take any medication or seek any other medical treatment beyond what a normal person my age (26) would need. We did wonder if they really turned us down because as a young married couple, we intend on having kids sometime soon-ish, and maybe they wanted a way to wiggle out of the insanely high cost of pregnancies and delivery, or the cost of care for a future child with my disorder (which does require medical care and medication in childhood).

Then I started working at my current job, and I got Blue Cross through my company plan, which meant BC couldn't turn me down. Ha, ha!

So yeah, be honest on the application, but recognize that you can get rejected for coverage on the stupidest of pretexts--rejected for reasons that probably wouldn't even have cost the insurance provider any money!
posted by Asparagirl at 8:16 AM on January 19, 2006

As others have said - be honest. You're better off never getting the insurance and not paying premiums than you are having them refuse to pay a few years down the road when they discover you lied. Which they will, since part of your agreement with them opens all your medical records to them, past and present.

Whether or not they'll refuse you - It depends on the insuring party. Kaiser refused me based on a history of depression, even though the extent of that was a few shrink treatments and ongoing medication with prozac, a drug that's available in generic form and which is so cheap ($19 for 3 months supply at Costco) that I don't even bother to claim it under my perscription coverage. Blue Cross/Blue Shield didn't seem to give a damn and my premium was exceedingly reasonable.
posted by phearlez at 8:35 AM on January 19, 2006

it's useless hyperbole until you prove those statements, and that's coming from a *strong* dissenter in the state of US healthcare.

See Peter Jennings' health care documentary before he died, and see patients I see in the clinic I volunteer at.
posted by gramcracker at 4:47 PM on January 19, 2006

I'm in my mid-20's and generally healthy. When I applied for individual health insurance last summer, I disclosed that I'd had migraines. I'd been diagnosed with them a few years before and had refilled my prescription for Imitrex a few times before switching back to Alleve. That was enough to bump me up to a more expensive, higher deductible plan ($2500 for medical, $1500 for prescriptions). Luckily I got hired full-time a few months later and get no deductible insurance for less than half the price.

If you're unfortunate enough to get a similar plan, I recommend Costco for prescriptions. They are the cheapest and you don't need a membership to get prescriptions filled there.
posted by booizzy at 6:49 PM on January 19, 2006