Cutting Corners on Health Insurance Applications

If you think you are going to get away misrepresenting your medical history on a health insurance application you are dead wrong. This advice goes for the applicant as well as the agent assisting.

I participate in several online forums, offering advice on health insurance matters for a nickel.

Actually, I don’t charge anything but my avatar is Lucy of Peanuts fame offering psychiatric advice for a nickel. I may not be as wise as Lucy, but I do enjoy the interaction.

One forum had a post from an “outsider” whose COBRA was expiring. He had sought the advice and assistance of an agent who quickly suggested a plan then rushed him through the application. The application was completed and submitted.

Later when the applicant actually reviewed the application he found “15 errors” and decided to post information on a forum in an attempt to find out how to handle this issue. The following items were left off his medical history.

These are all within the last 10 years:

Rhinitis – Allergy immunotherapy (ongoing )

Dry Eye – keratoconjunctivitis sicca (ongoing)

Sjogren’s Syndrome TEST (potential cause of dry eye) LAB RESULTS NORMAL

Prostatitis – pain from enlarged prostate – (released from care)

Metatarsarsalgia (released)

Bulging Discs and/or Disc Joint pain (physical therapy prescribed, no surgery)

Shoulder – partial tear of right rotator cuff (physical therapy prescribed, surgery is by choice)

Recurrent Fibroma on plantar fascia (avoid surgery)

Near Sighted & Astigmatism (Eye glass/ contact lens Rx)

Midcarpal Instability (excersize recmd’)

Knee Pain (released)

Giant Papillia Congitis (released)

Hairloss (Propecia Rx)

Cyst-benign on scalp (one removed on back)

Inguinal Hernia Repair Surgery (2)

Planter Fascia Fibroma Repair Surgery

Receding gums

High Cholesterol check (just modify diet, no rx)

Anxiety and depression (took 3 meds 6 years ago)

Anal Fissure (released)

Flat feet pain (orthotics made)

Ingrown toenail (released)

TMJ- Temporomandibular joint disorder (bite guard made)

Dry Lip problem

Acne

Pneumonia mild case

Deviated septum diagnosed (no treatment)

This is quite a list, and some of the things did not need to be included in the medical history. Hair loss, receding gums, dry lip, flat feet and an ingrown toenail are non-issues unless there is something more sinister to the condition.

The rest of the conditions should not have been omitted from the medical history.

After reviewing the data, several agents (to my surprise) suggested he cancel the application then file a new one with the same carrier or possibly a different carrier. All suggested he get the advice of a competent agent and, justifiably so, condemned the assisting agent for such shoddy work.

I took a different trek.

The short answer is, this person will not qualify for medically underwritten health insurance with any carrier. He is deemed a “basket case” and “repeat offender” who (so it seems) goes to the doc at the drop of a hat. The medication he is taking is rather expensive, running over $300 per month. He has no less than 3 issues that could well require surgery running in the thousands of dollars.

When I suggested he abandon any hope of finding major medical coverage he was incredulous. His view is, there is nothing really wrong with him.

Well, that is a matter of perspective.

He never revealed his home state, so no way to know which options are best. But depending on where he lives there may be a risk pool, a carrier of last resort, open enrollment or HIPAA conversion.

One agent suggested he start a business and hire a second employee so he could set up a group health insurance plan.

I thought that was off the mark since he had not established a business in the 18 months he was on COBRA so what are the chances of doing so now and getting it up an running in less than 30 days to the point of even qualifying for, much less affording a group health plan.

I have never understood why people like to deal direct with home offices rather than using the services of an agent. I interact with carriers daily and can tell you that unless you know the right questions and who to ask you will almost never get a solution to your problem.

And it seems many people don’t take the time to interview agents. If there is any direct involvement at all it is only to get a rate and maybe ask a cursory question.

Your agent can be your best advocate or worst enemy. If you don’t bother to ask questions and interview prospective agents you may never know if you have a good one or not. Having dealt directly with agents for over 20 years as a home office employee I can tell you the “good” agents are hard to find. That is sad, but true.

People who fill out applications by themselves either give too much information or not enough. Either way diminishes your chances of getting a good offer.

There is an art to completing an application in such as way as to give the underwriter everything they need to properly do their job without overwhelming them with extraneous items that cause them to shut down and simply deny your application for coverage.

You offer as much as they need and nothing more. If the underwriter needs additional information they will come back and ask.

In the last 90 days I have placed coverage for 5 individuals who were rejected for coverage with one or more health insurance companies. One individual was actually placed with a company that had rejected him a few months earlier. It was simply a matter of cleaning up his application and providing enough information so the underwriter could say yes.

I specialize in hard to place clients and have better than a 90% success rate if I agree to take on your case. It is never easy and sometimes can take weeks from start to finish but the reward is in knowing I have helped someone find the coverage they need at a price they can afford.

Oh yeah, we also take on the easy cases. Every chance we get . . .

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