Applying for US Health Insurance

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(Note to my readers: I try not to edit pages, but this page had to be updated so that I could include the “Tips for Applying for USA Private Insurance” into the body of post.)

Recently, I learned just how difficult applying for private health insurance can be in the United States.

As I was going off my group health insurance, I needed private coverage. Through the assistance of my insurance agent, I completed the initial on-line application in less than an hour.

That was the easy part.

A week after completing the application, I got a call from what is called the “medical” department of the insurance company for a follow-up to my application.

And here’s where things got a bit rough.

I was totally unprepared for the type of questions I was asked. The woman who interviewed me asked about medical claims, most of which were not recent. She wanted very detailed information that is kept in my medical records and not at home.

In addition, some of her questions seemed totally inappropriate. For example, she asked me what BRAND of over-the-counter vitamins I took and if I had taken my vitamin that day!

I tried to be helpful, but rapidly realized this wasn’t meant to be a friendly call. After repeatedly answering “I don’t know,” I asked her to contact my doctors. Instead, she continued to ask me the same questions over and over again. After an hour of grilling me, she finally agreed to a three-way call to my doctors, who answered her questions.

By the time I hung up the phone, I felt like I gone three rounds with Mike Tyson. I was both frustrated that I couldn’t answer her questions and emotionally exhausted by her aggressive attitude. From the beginning, she treated me as if I was guilty of some crime when all I had done was apply for private health insurance.

However, this story has a positive side to it.

Because of what happened to me, I decided to learn about my rights when applying for private health insurance. It’s my hope that what I learned may help you, or someone you know, avoid what happened to me. I have compiled a list of tips that might help you if you are applying for health insurance in the United States.

I hope you find the following suggestions helpful.

Tips for Applying for USA Private Health Insurance

Before You Apply…

Do not let your current policy expire prior to seeking new coverage.

If your policy is being cancelled, you can go on COBRA, which is short for the Consolidated Omnibus Budget Reconciliation Act.  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

Talk to your physicians about your medical records before you apply.

For private insurance, companies can review your medical history for the past ten years.  Therefore, be sure your records are up-to-date and talk with your physician(s) about any health issues that might get red-flagged.

Get 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

Find out your state’s policies related to private health insurance.

Every state may have certain exceptions or variations regarding coverage available.  Most states have this information on-line. Go to your state’s governmental web site and do a search on “private health insurance” or “health insurance policies.”

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 copy can be obtained once a year for free by calling (866) 692-6901 or by visiting the company’s web site at http://www.mib.com/html/request_your_record.html.%20

Consider going to a qualified independent insurance agent.

An insurance agent will know the private insurance regulations for your state and help you through the application process. To find an agent in your area, go to: http://www.nahu.org/consumer/findagent.cfm

Get a printed 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!  This includes “misstatements.”  Even if you didn’t intend to leave something off your application, it could still cause you problems. So, read over your application carefully to be sure you’ve answered the questions accurately!

If you get a follow-up call…

Answer only the questions asked.  Do not volunteer any additional information.

Be courteous, but remember the person interviewing you is NOT your friend or even your medical doctor.  In these types of interviews, you have NO privacy protection.  In addition, the interview will most likely be taped. So, think before you respond.

If you don’t know the answer to a question, simply say that.

I recommend you get comfortable with saying, “I do not have that information, please contact my doctor for it.”  Also, when asked specific questions about medical procedures, don’t try to guess.  Instead refer them to your doctor(s) and your medical records!

Be honest, but stick to the facts regarding your medical history.

The company you are applying to is likely to have access to your MIB file, meaning they already know certain aspects of your medical history.  If you are caught lying, you can be denied. As most applications ask if you’ve ever been denied for health insurance, a denial can be immediate “red flag” on any future applications.