Often, getting a health insurance company to actually offer you a policy after you apply can be a daunting task. Many people apply directly to an insurance company without the assistance of a professional insurance broker or agent.
Perhaps you see a television commercial aired by Blue Cross Blue Shield of Arizona and you call the toll free telephone number that was in the ad. You might end up talking with a person whose only job is to get you to give them your mailing address so they can send you the insurance company’s sales material. When the sales package shows up at your house, you’ll find somewhere among all the sales material the application that you’ll need to complete and mail back, then you wait to see if your policy gets approved.
In the above scenario, the individual may or may not have filled out the application in a way that increases their chances at approval. This is where an insurance broker can really help out. We do not recommend that anyone ever apply for any type of insurance without the assistance of an independent professional insurance agent or broker. It is a free service, and as long as you find an experienced agent, it can only help you. Many people are not aware of the importance that an agent or broker plays in the insurance purchasing scenario. For example, here are four very important tips that may help you apply successfully for health insurance:
1. All health insurance companies ask you about your medical history, and almost all only want to know about your health for the previous “x” number of years. If the medical questions section of the health insurance application starts off with something like “tell us about any health conditions you’ve had during the past 10 years,” and you had a kidney stone 12 years ago and have never had a recurrence since then, do not tell them about it. I repeat – do not tell them. If they wanted to know about something from 12 years ago, they would have said so. You are not committing insurance fraud if you don’t mention it, and you are making a mistake if you do mention it.
By telling the insurance company about a problem you had over ten years ago, you may be giving the insurer the opportunity to remove that condition from your policy. For example, let’s use the example of kidney stones. The insurer might now issue you a policy, but without coverage for kidney stones during the first year of your policy. They can legally do that. If you did not mention the kidney stones, as you are legally allowed to do under the 10-year look back, that condition would not have been removed from your plan.
2. If you have a health condition that is present at the time you are completing the application, you MUST mention it. You may think it’s not important and you may think “hey, I don’t need to tell them about it. It’s not a big deal. I’ve told my doctor about it, but she said not to worry about it unless it keeps coming back.” Just because a diagnosis has not been made yet does not mean that you can keep the problem a secret from the insurance company. Maybe you get a lot of stomach aches. You lie down for a while and the pain goes away for a week or so until the pain comes back again. Perhaps the problem is that you just eat too fast and swallow a lot of air, or maybe you have an intestinal blockage that could put you in the hospital where you’ll need expensive emergency surgery.
So you apply for the policy, and you don’t mention your stomach aches. After you’ve been on the policy for six months, your stomach pain is so severe that you go to an emergency room where the doctors run a lot of tests to see what is causing your distress. Turns out that you’ve got gallstones, and you need to have your gallbladder surgically removed. You spend three days in the hospital and go home. A week or so later, the bills start to arrive in your mail.
The hospital sends you a bill for $45,000, and says “do not pay this. This is for your records only. Your insurance company has been billed.” But your insurance company, before paying any of your bills, asks your doctor for copies of all your medical records before they pay anything. In your records, they find where you talked with her about “stomach aches.” They decide that your gallbladder problem was a pre-existing condition that you didn’t tell them about, and they refuse to pay any of the bills.
Be sure you at least mention every problem that your doctor has written into your medical records over the previous 10 years.
3. If you currently have a medical problem (no matter how minor) where no diagnosis has been made yet, the typical insurance company will not offer you a policy. On your application, if you write down that you have “left knee pain,” the insurer will insist on knowing when it started and what is causing the pain. If you can’t tell them WHY you have left knee pain, most insurance companies will respond to your application with something like “sorry, we won’t issue a policy to you at this time. Get a medical diagnosis describing what’s wrong with your left knee, and then you can reapply.” One of the major insurance companies that we represent will decline to give you a policy if you write “I currently have the flu” on your application.
This section is certainly not trying to tell you to conceal these types of pre-existing conditions. What we are trying to tell you is that you should wait to apply for a health insurance policy (a) until you have a diagnosis for any medical condition you may have, and (b) don’t apply for a health insurance policy “while” you are sick.
4. Sometimes you may be turned down for a health insurance policy, yet you know that you are in perfect health, and you are sure that the medical records at your doctor’s office reflect that fact. In over 20 years of marketing health insurance plans in Arizona, we have seen many instances where a doctor’s office sent the wrong medical records to an insurer. Sometimes in a very busy medical practice, someone else’s medical records may get inserted into your medical records accidentally, and those records get sent to the insurance company when your medical records are requested prior to issuing a policy. If you are declined for a health insurance policy and you have no idea why, it is imperative that you respond to the insurance company’s letter declining to offer you a policy. Find out why you were turned down, and get copies of your medical records to back up the reasons why the insurance company should change their mind and offer a policy to you.
If you need help in obtaining a health insurance policy and you live in Arizona, give us a call at (800) 600-9663, or fill out our online quote request form. We’ll do all we can to see that you are successful in your search for an Arizona health insurance policy.
