Insurance question

[SGB]

I'll tell you one thing, if I had known that taking an antidepressant would cause her to be denied, I would have just not submitted claims for that doctor and the meds so it wouldn't be on her record.

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.

 

[Allifunn]

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.

exactly!

 

[Allifunn]

Correction...for those who care the surgery is the 27th and the pre-op or whatever you call it is the 17th. Nevertheless, I am not looking forward to it.

You will do fine...post after your surgery and let us know how you are!...goofy feeling and all! You will be PUI...of legit drugs....

 

[rapunzel]

I have worked for and with insurance for many years, and my suggestion would be to get a hospital surgical policy if you are fairly young and healthy with the exception of the skin cancer issues. Chances are you'll be much better off paying for a yearly check up and a derm visit out of pocket than paying premiums on a traditional policy. The policy is there if you have any illness that would cause real financial hardship, and it counts as coverage as far as pre-existing issues go. Also, a lot of doctors are willing to give discounts for self-pay patients. In Louisiana, a doctor may charge $125 for an office visit but BCBS only paid $47 so our group was always quite happy to give cash patients a $50 discount. If you go that route you'll probably end up spending as much at the doctor as you would going to the hairdresser over the next year. It's way better than COBRA unless 1) you take a lot of brand name medication for which there is no substitute or 2) you plan to have a baby anytime soon.

 

[Allifunn]

I have worked for and with insurance for many years, and my suggestion would be to get a hospital surgical policy if you are fairly young and healthy with the exception of the skin cancer issues. Chances are you'll be much better off paying for a yearly check up and a derm visit out of pocket than paying premiums on a traditional policy. The policy is there if you have any illness that would cause real financial hardship, and it counts as coverage as far as pre-existing issues go. Also, a lot of doctors are willing to give discounts for self-pay patients. In Louisiana, a doctor may charge $125 for an office visit but BCBS only paid $47 so our group was always quite happy to give cash patients a $50 discount. If you go that route you'll probably end up spending as much at the doctor as you would going to the hairdresser over the next year. It's way better than COBRA unless 1) you take a lot of brand name medication for which there is no substitute or 2) you plan to have a baby anytime soon.

thank you, this makes alot of sense! Much of what I have thought of myself...but you put it into perspective...
PS....NO BABY!!!!! way beyond that....;-)

 

[audie]

Correction...for those who care the surgery is the 27th and the pre-op or whatever you call it is the 17th. Nevertheless, I am not looking forward to it.

i will be thinking of you - i totally understand the not looking forward to it ! i hope your experience is as good as mine just was - if so it will be a breeze for ya !

 

[Beach Runner]

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.

 

[Jdarg]

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!

 

[Beach Runner]

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.

 

[Jdarg]

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.