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Old 09-01-2009, 11:17 AM
 
125 posts, read 407,783 times
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Default How do insurance companies know about your pre-existing conditions?

I don't really understand existing conditions. If I switch insurance companies, and fail to report an existing condition, how would they ever know if 'was' an existing condition if I switch doctors? Do insurance companies share files or something?
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Old 09-01-2009, 12:22 PM
 
Location: Long Beach, CA
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Yes, they have the authorization to get your medical conditions from your physician. It's better to be honest. I know there are insurance companies that will accept pre-existing conditions.
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Old 09-01-2009, 12:29 PM
 
Location: Tucson, AZ
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If you switch insurance companies, you should get what's called a Certificate of Creditable Coverage or a HIPAA certificate from your old insurance. Submit this to your new insurance carrier. Plans/companies vary, but the longest they can exclude a condition as pre-existing is 18 months. If you've had 18 months continuous coverage you're fine. Some comanies only exclude pre-x conditions for 12 mos, or 6. It depends on the plan. Also, one very important thing is this applies to group health coverage only (the type you get from an employer) - not an individual plan. Individual plans are a completely different animal, of which I have no experience so I won't even try.

If you don't have enough creditable coverage to cover the pre-x exclusion period, your new insurance company may do an investigation. Typically, they'll generate a questionnaire to you asking what physicians you've seen during a time period prior to your coverage (known as a look-back period). They'll also send similar letters to any doctors you list on your questionnaire, as well as any doctors they have received claims for that could be considered pre-existing (like an established office visit w/a diagnosis of diabetes). Depending on how your doctors respond, you may be subject to pre-existing limitations.
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Old 09-01-2009, 01:04 PM
 
Location: SC
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Quote:
Originally Posted by JBower View Post
I don't really understand existing conditions. If I switch insurance companies, and fail to report an existing condition, how would they ever know if 'was' an existing condition if I switch doctors? Do insurance companies share files or something?
What you need is a good independent insurance agent who ONLY does health insurance and has been doing it for several years who you can give your health history to and then they can shop different carriers without revealing your identity but find out for you what the likelihood would be of insurance companies accepting you with your pre-existing condtions and at what rate and what would the terms be etc etc. That way you can save yourself from applying and getting rejected needlessly (which stays on your record forever and is a black mark against you whenever you go again and apply for life or health insurance because they always ask if you were ever turned down for insurance).

The agent can say to prospective carriers they have a client with XYand Z pre-existing condtions etc and then get back to you with what they find out and help you decide.

The other main reason you always want to be honest is that before the insurance company pays the first claim, they will check your medical records to make sure your health history is consistent with the way you answered the medical questions. If it isn't they will consider it a fraudulent application, return your premiums and not pay the claim.Be careful though to only disclose what has actually been diagnosed and treated that is in your medical records. You DON'T have to offer information about every little ache or pain you ever had -- opening up unnecessary cans of worms which can result in being rated up above the standard rates to a higher level than is necessary.
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Old 09-01-2009, 01:39 PM
 
125 posts, read 407,783 times
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Originally Posted by emilybh View Post
You DON'T have to offer information about every little ache or pain you ever had -- opening up unnecessary cans of worms which can result in being rated up above the standard rates to a higher level than is necessary.
I think this is where my confusion lies. I do have an ins. agent who is shopping around. But I've been to several docs over the past 6 years for things that most likely will never come back. But if they DO, I'd like to think I'm covered. So should I report those office visits? Even if its unlikely those aches and pains will come back?
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Old 09-01-2009, 10:28 PM
 
Location: Santa Cruz, CA
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Quote:
Originally Posted by JBower View Post
I think this is where my confusion lies. I do have an ins. agent who is shopping around. But I've been to several docs over the past 6 years for things that most likely will never come back. But if they DO, I'd like to think I'm covered. So should I report those office visits? Even if its unlikely those aches and pains will come back?
One of the people that was interviewed for the documentary "Sicko" (about the disgusting practices of the insurance companies) was one of the folks who's job it was to do everything possible to find any and all reasons for the company to deny a claim or request for coverage.
And he (who finally quit) an others like him are extremely savvy and aggressive when it comes to finding the info the insurance companies need.
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Old 09-01-2009, 11:01 PM
 
Location: Raleigh
784 posts, read 1,464,606 times
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Quote:
Originally Posted by JBower View Post
I don't really understand existing conditions. If I switch insurance companies, and fail to report an existing condition, how would they ever know if 'was' an existing condition if I switch doctors? Do insurance companies share files or something?
It is really simple. If you come down with something that is typically chronic, then it must have existed before. They will search your history. They do share data on patients. Of course, part of the new government plan is a unified database, so you will be completely screwed.
"isn't that what I said LAST year?"
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Old 09-02-2009, 11:47 AM
 
125 posts, read 407,783 times
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Quote:
Originally Posted by Crashj007 View Post
It is really simple. If you come down with something that is typically chronic, then it must have existed before. They will search your history. They do share data on patients. Of course, part of the new government plan is a unified database, so you will be completely screwed.
"isn't that what I said LAST year?"
It is simple, but at the same time, it makes no sense and boggles the mind. Think about it, if the insurance companies already know my entire claim history through their shared database, then WHY do they need me the applicant to write it on the application? I've been to a lot of physicians over the years, it is possible that I could forget to list one of my past conditions, it could come back up, and I'm screwed. And if they ask you because they are gauging your honesty, then what difference does it make if they already know my history? It's crazy.
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Old 09-02-2009, 12:17 PM
 
Location: Santa Cruz, CA
2,893 posts, read 7,569,778 times
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Quote:
Originally Posted by JBower View Post
It is simple, but at the same time, it makes no sense and boggles the mind. Think about it, if the insurance companies already know my entire claim history through their shared database, then WHY do they need me the applicant to write it on the application? I've been to a lot of physicians over the years, it is possible that I could forget to list one of my past conditions, it could come back up, and I'm screwed. And if they ask you because they are gauging your honesty, then what difference does it make if they already know my history? It's crazy.
If i'm remembering correctly, to lie on the application about any conditions, past or present, is grounds for the insurance company to deny you treatment.
In that film i mentioned (and again, i think i'm remembering correctly), one woman didn't mention that she had once had a yeast infection! and then when the time came that she needed some serious treatment, they used that omission against her.
Also, it was my impression that the companies do that really hard core research into your medical history only when/if you get sick and need them to support the treatment that you need.
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Old 09-02-2009, 12:31 PM
Status: "Chin up things can only get better" (set 8 days ago)
 
Location: South Bay Native
9,625 posts, read 12,816,516 times
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Medical Information Bureau - MIB - it already exists. IntelliScript and MedPoint - have a prescription for a medicine that treats a chronic illness? Well, then they know about it.

Here's an informative link that you may find helpful:

Medical Records Privacy
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