Quick Insurance Tips

Insurance appeal letters will sometimes cause a health insurance company to ultimately overturn a denial and approve an applicant or approve that applicant at a lower rate. It never hurts to write an appeal letter. However it is not the only option to get an insurance policy for heath care after you have been denied. It is not usually the best option.

Unless you have been denied or charged extra based on incorrect or outdated medical information, you are not likely to get your insurance company to change its mind. A better strategy for most is to apply to a company with different underwriting guidelines.

Underwriting is the process of deciding who to insure and what rate class to assign to those who are approved. This process involves looking at the application and sometimes requesting medical records from a doctor or other health care provider.

Underwriting is done differently by different companies. Although a person with an active cancer or a recent heart attack is likely to be denied by all companies that medically underwrite their policies, there are a lot of areas where the insurers underwrite differently. They can look at the same information from the same medical provider and make different decisions.

The carriers will have different height and weight guidelines. They will have different ways of measuring the impact different conditions will have on your potential claims and therefore insurability. So don’t think that if you have been denied for a policy with one carrier based on a provider’s report, that another carrier will make the same decision

An experienced agent can keep you from having to write an appeal letter. An agent who has a working knowledge of the underwriting guidelines of the health care insurance carriers in your area can point you in the right direction and help you avoid another rate increase or denial. Although the insurance companies never release all their “underwriting secrets,” they do share a watered down version of the guidelines with agents and brokers.

Health insurance for pre-existing conditions may be available to you. The availability is based on the condition you may have and the various medical guidelines of the different companies that provide health insurance benefits in your area.

While you may be able to find insurance coverage for a pre-existing medical condition in certain circumstances and MediGap insurance without pre-existing conditions issues is available in most situations, forcing insurance companies to insure all comers would prove disastrous to our present system.

About a decade or so ago the State of New York forced the insurance companies to insure everyone regardless of their medical history. What happened? Almost all of the health insurance companies serving the non-group market fled the state. The remaining providers were forced to raise their rates beyond an amount that most could afford.

Basically what happened was that sicker people started buying health insurance policies. They cost the insurance companies more than they paid in. This forced the companies to raise their rates. This meant that fewer people could afford to keep their coverage. Those that were already sick squeezed their budgets tighter to keep their coverage when they could. This meant that more healthy people dropped their coverage than unhealthy people did. The companies raised their rates again. This cycle continued and continued.

Guaranteed medical insurance will only work when there is universal health insurance. When healthier people are allowed to opt out of the system, the rates just go up and up.

What is a Pre-Existing health condition?

Before looking at expensive or restrictive policies, make sure that the pre-existing condition you are concerned about will actually prevent you from getting coverage. Sometimes the medical condition that causes an individual concern, is not one that causes an insurance company the same level of concern. Health insurance for high risk individuals can be hard or impossible to find, but getting information and quotes from various sources will keep you from paying more than you should.

High blood pressure, high cholesterol and even a diagnosis of cancer may not be enough to get an applicant denied when applying for a medical insurance policy. In the state of Connecticut an applicant with high blood pressure or high cholesterol will usually find that most of the underwritten private health insurance plans are available to him or her, unless there are other negative aspects to his or her medical history. Many people who have had cancer will also find that they will qualify for a policy. However, an active cancer is treated differently than one that hasn’t required treatment for a period of time.

Medical Insurance Companies Have Different Rules

If you have had a stroke or a heart attack in the last couple of years, you will not be able to find a private health insurance company that will insure you unless they are forced to due to regulations. However, many conditions such as allergies, obesity and diabetes are treated differently by different insurance companies. For example Blue Cross in Connecticut might deny a particular client who has sleep apnea. Aetna may accept that client, but will charge him more each month than a more healthy client. United HealthOne might insure that client, but refuse to cover him for the sleep apnea. Depending on the condition, you might get different answers from different companies.

It pays to query the different companies or to work with a broker who works with multiple companies and who can do that for you.

Group health insurance may be available to you even if you can’t find coverage on your own. If you or your spouse are employed and have group health insurance as an option this will probably be the best choice for you. Medical insurance options may be available to you from a local, state or federal sponsored plan. A local health insurance broker may be able to point you in the right direction. Your state’s health department or local hospital may also be sources of good information.

Our pre-existing medical conditions affect the cost and availability of health insurance especially in the private market.

Usually obese workers are not charged more for health insurance on their group plan, however, when they leave their jobs and seek to purchase private medical insurance, they are often charged more and sometimes they are denied coverage. Perhaps one day this will change, but this is the way that individual healthcare insurance works today in most areas of the United States.

What is considered Obese?

A BMI or Body Mass Index at or above 35 is considered obese by many private health insurance companies. You will need to check an individual insurance company’s tables for height weight to see how a particular company looks at this issue. Some companies are more liberal than others.

In some cases an extra pound or two can have a significant impact on your rate. You can check your BMI online before entering into a conversation with an agent about health insurance. If your BMI is close to or above 35, you may want to ask him or her at what point you will be considered over weight. If you are close to that number dieting for a week may mean that you pay a lower premium for the next several years.

Even if you are thin, you may want to ask if your weight will impact your coverage. Some companies have preferred ratings classes for this with BMIs that are lower than average.