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Unless you have been denied or charged extra based on incorrect or outdated medical information, you are not likely to get your insurance company to change its mind.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.

Until all the health care mandates go into effect, we can still be denied health insurance due to our health histories. Although some insurance denials are unavoidable, many are avoidable.

It is very important that you never cancel an existing health insurance policy until you have an approval for the new one you applied for. Doing so can mean that you if you are denied coverage by the new company, you will be unable to be covered by the old policy either.  This is especially true if you need health insurance for a pre-existing condition.

You can do this by applying early. Request an effective date that is 2 weeks or a month away from the date you applied. This way you are likely to hear about your approval early enough to cancel the old policy and not double pay for coverage.

Getting an examination just before applying for a new health insurance policy can backfire on you. A condition that is discovered during your examination may result in a denial for the new policy.

Of course there are health reasons why you should get an exam sooner rather than later. A malady we are unaware of can hurt us. However, we need to weigh the benefits of having an exam as soon as possible with the potential negatives that come with having a medical record of the condition just before we need to change our coverage.

You may be able to avoid being without health insurance coverage by applying with a second company if you are denied by the first. Shopping around for insurance should not only apply to price and benefits, but also coverage specific to pre-existing conditions. You may find that a condition that causes you to be denied by one company will not be a factor when you apply with another company.

In 2014 the health care reform mandates will be in effect. Hopefully at that time concerns about medical insurance denial will be a thing of the past. For now, we may need to be thoughtful when it is time to change our health insurance coverage.

Private medical insurance prices are influenced by several factors.  You may be able to lower your cost for health care by eliminating unneeded coverage, by increasing your fitness level or by shopping around for coverage.

Medical insurance is expensive today because the cost of a hospital stay and the cost of a doctor’s visit are expensive.  The cost of health care rises each year as healthcare providers ask for more, more expensive procedures become available and hospitals charge more for their rooms.  By reducing your insurance company’s costs you may be able to reduce your cost as well.

You may be able to reduce coverage for certain benefits that you don’t need or that are more expensive than they are worth.  Maternity insurance, prescription coverage and dental insurance may be either unnecessary or over priced.  People often pay extra for a policy that includes maternity insurance long after they have had their last child.  Prescription coverage and dental coverage will often have relatively low annual limits.  If so, the amount you would have at risk if you eliminated one of these benefits is the amount of the coverage limit less the cost of the coverage.  This may mean that dropping the added cost is a good idea.  Spend some time looking at the limits and the costs of these benefits and do the math to make sure that they are worth keeping.

Raising your deductible may also reduce your costs. By taking more or the risk, you can often reduce your costs by a lot. In some cases the amount of extra risk you take may be less than the amount of money that you save. Make sure than when you compare your premium savings to an increase in your deductible you multiply the premium savings by the appropriate factor to get the annual savings. Your deductible is probably based on a calendar year. You should compare it with the annualized savings to make an apples to apples comparison.

If you have been charged extra because of a medical condition or because of your weight, you may be able to reduce or eliminate the surcharge.  You should find out what needs to happen in order to get your rate reduced if this is the case.

Often an insurance company will reduce or eliminate the surcharge if you have had a period of time where you haven’t needed treatment.  If your preexisting medical condition has gotten better, you may be able to get your rate reduced.  You may need to lose a small amount of weight or reduce your blood pressure readings by a small amount.  Knowing what requisite numbers may motivate you to do the things you need such as exercise or eat better.  You may be able to save more than just money by doing what it takes to get your health insurance premiums down.

Shopping around is a tried and true practice for saving money on health insurance, cars and many other things.  There is often a large variance in medical insurance prices.  You may find that you can save hundreds of dollars a month by switching to another company or even to a different type of policy that is offered by the same health insurance carrier.

There may be several factors that you have control over that will impact your cost for health insurance and health care in general.  Reducing your coverage in unimportant or unneeded areas, reducing surcharges for pre-existing conditions and shopping around can all help you bring your costs for health insurance down.

Should you pay for your insurance on your credit card?  Will this make your insurance cost more or less?

Many carriers are encouraging their policy holders to pay via credit card today.  This has both pros and cons.  It may mean that you have coverage when you need it.  It may also mean that you are paying 20% extra for your policies and are getting deeper in debt.

By allowing your insurer to debit your credit card for your auto insurance or health care policy, you may keep your insurance in force longer.  This may mean that an accident or other even is covered when it might not have been. Forgetting to pay an insurance bill can cost you thousands or even millions.  There is definitely a positive side to paying for insurance via a credit card.

If you have a medical condition or have gained weight that you acquired since you purchased your health insurance policy, this can be especially important.  Missing a payment may mean that you are denied coverage or charged extra for the same coverage you had before.

Your health insurance company is not allowed to drop you because of a significant health condition or a state of obesity that you developed since your healthcare policy was approved unless you cancel your policy or allow it to lapse.  If you do so, you can be treated as if you are a new client.  This can mean that you are subjected to medical underwriting all over again.

If you are in the habit of paying your credit cards off each month before any interest is assessed, there no downside to using a credit card to pay your monthly insurance premiums.

However credit is overused today.  How would you feel if you were charged 20% more for everything you buy because of your race, gender or religion?  When we use a credit card to pay, we often pay an extra unnecessarily.

Insurance plans that will charge your credit card by default may be willing to send you a bill in the mail or bill a checking account.  If you are concerned about excess interest charges, you may want to contact your insurer about this.

A preexisting health condition can prevent you from qualifying for medical insurance.  Timing your applications and medical examinations can keep you from being denied coverage in certain situations.

Timing your Medical Exams

A preexisting condition becomes an insurance issue when one of three things happens.  You receive medical advice for the condition. Your have symptoms that would cause a prudent person to seek medical advice.  Your insurance company discovers the condition during an exam.

If you are considering changing insurance policies you may not want to see a doctor until you have been approved by the new company.  Why?  If you are genuinely unaware of a medical condition and haven’t had symptoms that would cause you to seek medical attention an insurance company should not hold that condition against you unless it is discovered during their underwriting process.

If you have a medical examination just before applying for a new policy, your physician might discover a condition that would keep you from being approved for your policy.  You may be better served if you wait until you are covered by the new policy before you are examined.

Of course, there may be situations where waiting even a week to have an exam could have serious repercussions.  On the other hand if a serious condition is discovered a week earlier the timing may save your life.

However, if the treatment for the condition isn’t covered because your old policy expires shortly after your diagnosis, you may not be able to complete your treatment.

This is not medical advice. You will have to weigh the pros and cons of waiting verses not waiting to have an exam.

Aging of Preexisting Conditions

Not all medical conditions get worse with age.  Some are treated more favorably as they age.

A person who was diagnosed with a condition too recently may be denied coverage even for a minor condition.  This is because the insurance company wants to make sure that the diagnosis was accurate and that the treatment prescribed works.

A person who was diagnosed with asthma a year ago and has their symptoms controlled with medications will likely be approved for a medical policy.  A person who was diagnosed a week ago may not be.

Often people with serious conditions like cancer are able to qualify for medical coverage.  This depends on the type of cancer and how long it has been in remission.  Five years without treatment or need of treatment can be enough for many cancers.  The waiting period for other cancers is much shorter.  For certain others the waiting period is longer.

Ask your insurance agent if he or she for guidance if you are concerned about being denied.  You may be able to keep a rejection off your insurance history simply by waiting to apply.

If You are Denied Health Insurance

Be aware that different insurance companies may underwrite the same condition in different ways.  Be sure to check with several companies if you have been denied insurance due to a medical condition.

You should also be aware that different types of policies will have different rules.  A group health insurance policy may accept you regardless of your medical history.  This may be true with state-sponsored health care programs.

Until we have Universal Health care, preexisting conditions will have a devastating impact on certain families and individuals.  You can reduce your chances of being denied a health insurance policy by delaying a health exam until after your new policy is effective (so long as it doesn’t jeopardize your health).  You can also reduce the chances of getting a denial by waiting to apply until a recently diagnosed illness is considered stable by a new insurance company.

The risk of paying higher taxes with universal healthcare should be weighed against not just the benefit of easing of pain and suffering and extending life, but also the benefits of the tax dollars that might be generated by those who aren’t hampered by the current system.  The person who is disabled today because he couldn’t afford health care when his condition was preventable might be working today.  He might be paying taxes instead of collecting from social security if we had a universal healthcare system.  The woman who today who is shackled to her job because a family member is uninsurable in the private health insurance market might be the person who invents the next great thing.

Better Preventative Health Care May Reduce Our Costs

Although it is true that the poor have access to health care today, the access is biased towards expensive care one might need in an emergency medical situation as opposed to the relatively inexpensive care one might need to prevent that emergency situation.

There must be countless men and women who are currently out of work and on the dole who would love to be working and supporting their families.  Few of us want to be out of work.  Fewer of us want to be sick and out of work.

In many cases the disabled former tax payers had relatively minor preexisting conditions that turned into major disabling conditions.  These conditions were only allowed to become major medical conditions because the person couldn’t afford proper preventative care.  The cost of this care pales in comparison to the cost of losing a tax payer and gaining a “tax eater.”

A Lack of Health Insurance Options May Reduce Innovation

Many people are afraid to leave their jobs because they are afraid of losing their healthcare coverage and slows our economy. This fear keeps people shackled to jobs that no longer fit them.  A person who has the ability and experience to do something bigger may stay at a job because the opportunity to do something else means that they will leave their coverage behind.  This doesn’t happen in the other countries that use a universal healthcare system.

The next Bill Gates or Thomas Edison may be forced to stay in their current job because they have a daughter with Crohns disease or a genetic defect.  They are not going to take the risk of leaving their job and create the next computer innovation or light bulb.  We lose and they lose.

A major innovation isn’t necessary for this to hurt us.  Small improvements multiplied by thousands or millions of workers could be enough to turn our economy around and drive us forward.  If John is forced to stay with a company with no advancement opportunities because of health insurance issues, he can’t work at another company that can use all of his abilities and make that company great.  If the same is true for Jane and Barbara and Dave… we are losing a lot of production due to this forced underemployment that is driven by the current system.

If universal healthcare can increase the number of tax payers and reduce the number of “tax-eaters” we may find that it improves our economy.  By helping those in need we may be helping every American whether rich or poor.

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.