Just like with auto insurance, if you use your health insurance policy for anything major, you might get turned down for future policies if you should decide to change your coverage. One of my friends had health insurance with drug insurance also. She has to have about $800 in meds every month. Her health insurance paid most of it, and she paid the co-pays. She had a policy with her employer. She is no longer insured with that company, because she had a baby and then became a day care worker when her baby was older. She tired to get another health insurance policy later on, and she was turned down. She said she was turned down because she used her insurance. Is that fair?
Just like your business, the goal of the insurance business is to make money. The insurance industry is a business associated with risks. You are banking on paying money to an insurance company to keep you out of the poor house (thank the good Lord we don’t have debtor’s prison). The insurance company is banking on you paying money to them also, but the kicker is they are betting that you won’t have to use it very much. We see commercials for health insurance telling us they will be there for us when we need them. That’s not entirely true all the time. If you cost them too much money they might find a reason to drop you… or if you did like my friend and try to get a new policy you will be out of luck.
Every health insurance provider has their own system of doing things. They set the rules in place, and those rules may differ from any other company. Why might your application for insurance get turned down? There could be any number of reasons. Remember the form you fill out for health insurance? It asks you for your complete health history. It asks for your mother’s and dad’s history too. These questions are clues to any red flags you send them. If you check yes for diabetes for your mom and dad, then chances are you will be diabetic if you aren’t already. Diabetes is a deal breaker for many insurance companies if they have it listed as a pre-existing condition.
What’s a pre-existing condition? A pre-existing condition is a condition for which you have been diagnosed and treated before you signed up for your policy. So when you check yes on high blood pressure, diabetes, asthma, and you check yes for smoking you are telling the insurance company you are a bad risk. When you check yes that you are taking medications for cholesterol and high blood pressure, you are telling them you are a heart attack waiting to happen.
Health insurance companies want to make money, not lose it. So if you are a bad risk, the insurance company will spend out more money on you than you pay for your premium. Actuaries (remember the movie “About Schmidt?” he was an actuary) have done the math to figure the risks involved with determining how many people in a population will come down with certain health conditions. So you might say, actuarially speaking, it’s all about the numbers. Medical underwriters take all the information on your application and cross reference it with the MIB data base into consideration and determine the risk of insuring an individual or a group of people.
Why else might you get turned down for health insurance? Let’s go back to the application for health insurance. Suppose you don’t want to disclose everything in your history. You might be afraid of being turned down, so you tell a little white lie. Lies always come home to roost, so don’t do it. Those insurance companies don’t just take your word as gospel. They have people. Those people are the Medical Information Bureau. That bureau knows more about you than your mama. Before you are accepted you will be checked out through the bureau. If the Medical Information Bureau is a data base, and it compares information that you have given in the past that has been submitted to them with the new information you put on your application. If the information in the MIB doesn’t jive with our application the underwriters can turn you down flat.
Let’s go on with some more reasons that you might get turned down for health insurance. Your mental health could be a factor. If you have mental health issues, and you have to see a psychiatrist and/or a therapist on a regular basis, and your psychiatrist put you on prescription meds for mental health issues, you could be turned down.
Other factors that could cause you to be denied is if you are pregnant, or you have been diagnosed with serious illnesses such as anorexia, HIV, AIDS, hemophilia, heart disease, chemical dependency and other conditions you could be turned down. Then again you might not be turned down. You might just be put in a risk pool. Some states have risk pools. You can have a policy through a risk pool if you can afford the premiums. Risk pools are for people who are otherwise uninsurable.
In closing, if you are self-employed, you will need some kind of health insurance coverage, or you could be financially devastated if something were to happen to you. If your spouse works in a public job and has insurance coverage, and you feel you can’t get a plan with a reasonable premium, you might consider letting your spouse insure you. Employer funded group health insurance is often the answer, when you cannot get coverage on your own.
Source:
http://www.ehealthinsurance.com/ehi/Consumer-Health-Insurance-Resources.ds?articleId=C1;A1-16;1
