Recently, I learned just how difficult applying for private health insurance can be in the United States. I was going off my group health insurance and needed private coverage. Through the assistance of my insurance agent, I completed the initial online application in less than an hour.
That was the easy part.
A week after completing the application, I got a follow up call to my application from the “medical department” of the company. I was told this was to verify some of the information on my application.
And here’s where things got a bit rough.
The woman who interviewed me wanted VERY detailed information on medical claims. Since the specific details she wanted were in my doctor’s medical records, not at home, I was unprepared for her questions. I made every effort to be helpful, but the call rapidly became an unfriendly interrogation.
For almost an hour, I was asked the same questions over and over until I felt like shouting, “Asked and answered!” For most of them I simply replied “I don’t know.” Eventually I asked her to contact my doctors. When she finally did, they checked my records and answered her questions.
By the time I hung up the phone, I felt like I’d gone three rounds with Mike Tyson. I was both frustrated that I couldn’t answer her questions and emotionally exhausted. She treated me like a criminal instead of a person seeking private health insurance. It wasn’t a good experience!
Because of what happened to me, I did some research. It helped me to compile the following list of ten things I believe anyone applying for private health insurance in the United States should know. I hope this list will help you or someone you know to avoid what happened to me.
BEFORE YOU APPLY
1. Do not let your policy expire prior to seeking new coverage.
If your policy is being cancelled you can go on the Consolidated Omnibus Budget Reconciliation Act (COBRA). This act ensures continuation of group health coverage that otherwise might be terminated. For information, go to: http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTMl
2. Talk to your physicians about your medical records before you apply.
For private insurance, companies can review your medical history as far back as ten years. Therefore, ensure your records are up-to-date and talk with your physician(s) about any health issues that might be red flagged.
3. Obtain copies of your medical records.
You can also request a copy of your medical records under the Health Insurance Portability and Accountability Act (HIPAA). For more information on HIPAA, go to http://www.privacyrights.org/fs/fs8-med.htm
4. Find out what your state’s policies are in relation to private health insurance.
Each state may have certain exceptions or variations regarding coverage. Most will publish this information online. Visit your state’s governmental website and search for “private health insurance” or “health insurance policies.”
5. Check to see if you have a file with the Medical Information Bureau (MIB).
The MIB is a central database of medical information shared by major insurance companies. If the MIB has a file on you, a free copy can be obtained once a year by calling (866) 692-6901, or by visiting the company’s website at http://www.mib.com/html/request_your_record.html.%20
6. Consult with a qualified independent insurance agent.
An insurance agent will know the private insurance regulations for your state and can help you through the application process. To find an agent in your area go to: http://www.nahu.org/consumer/findagent.cfm
7. Obtain a copy of your application and REVIEW it before you send it in.
Some companies may refuse a claim or terminate the policy solely because the information in the application is inaccurate. If you leave something out accidentally, it could cause problems. Read over your application carefully to be sure you’ve answered all the questions accurately.
IF YOU RECEIVE A FOLLOW UP CALL
8. Answer only the questions asked. Do not volunteer any additional information.
Be courteous and remember the interviewer is not your friend or your medical doctor. In these types of interviews you have NO privacy protection. In addition, the interview will most likely be recorded so think before you respond.
9. If you don’t know the answer to a question, be honest about it.
I recommend you get comfortable with saying, “I do not have that information, please contact my doctor.” When asked specific questions about medical procedures don’t guess, refer them to your doctor(s) and your medical records.
10. Be honest and stick to the facts regarding your medical history.
The company you are applying to may have access to your MIB file, and already know certain aspects of your medical history. If you are caught lying, you can be denied. Most applications ask if you’ve ever been denied health insurance, and a denial can be an immediate “red flag” on any future applications.
I hope you find these suggestions helpful. Just remember that when applying for private health insurance in the United States, the best policy is to adopt the Boy Scout motto of “BE PREPARED!”