Hello there,

All health insurance applications will ask you if you've seen a physician for a condition that will require surgery or further follow up. You would need to answer that question truthfully "yes" at this point, and unfortunately that would make you ineligible for coverage for that issue.
There are certain conditions that health insurance companies will treat as a pre-exisiting condition: Meaning they'll approve the policy but will not allow you to have coverage for that condition for a pre-determined period.
And then there are conditions that health insurance companies will treat as serious enough that they are not able to approve coverage until the issue is resolved.

General rule of thumb is that any time you have need for a surgical procedure, they health insurance companies will see you as a bad risk, and will not approve you until you've had that taken care of.

The best thing to do would be to contact a health insurance agent/broker in your area who would be most familiar with insurance underwriting guidelines and can give you guidance on whether or not it's worth your time to apply for the health insurance at all. They can call insurance companies and give them the general scenario and get a likely determination over the phone, so you won't waste your time filling out an 8 page applicaiton only to get declined.

Good luck!


Kathy K

Hey thanks for the info.

My fiance is a nurse and told me that since I copayed at a family doctor, that it would be illegal for health care insurance compaines to obtain that information. Is this true? She said that once I got health care insurance, I would go to a new family doctor, fill out all the forms and play it off like this is a new problem. Does this sound correct? Can health insurance compaines still obtain those medical records? I live in PA if that helps at all.

Thanks for your quick reply!

I am so sorry, I realized that I left out a lot of important information in the first post. I am going to re-edit it. Been a long day *sigh*

*edit* ok it won't let me edit my post so I am going to re-ask my question again and explain my situation a bit better.

I am a male, 29 years of age. I do NOT have health insurance. I recently found a lump on my bottom and went to a family doctor to get it looked at. I went to the family doctor WITHOUT insurance and payed WITHOUT health insurance, a copay of $75 dollars for the visit.

Now I am pretty sure that the family doctor I went to uses computers to store their information and peoples medical records and so fourth. They perscribed me some medicine, but never called up the pharmacy, but instead gave me a perscription to bring to the pharmacy.

Now knowing that I did not have insurance, if I where to try and apply for health insurance, would a health insurance company be able to obtain those medical records from the family doctor or would it be illegal?

Would they be able to get information from the pharmacy as well?

I will be honest in saying I am completely new to all of this. Would it be a bad idea to apply for health insurance and see if they grant me the health insurance or not by beind dishonest about my pre-existing condition?

Like I said, it has been a long day so sorry about my mistake in leaving out important information, like me not having insurance and so on.

Thank you and hope to hear from somebody soon!

Found this site outlining HIPAA basics.


Still not sure if an insurance company would even be able to find out that I had this check up since I had no insurance. I mean, ofcourse these days things are done electronically, but it's not like there is a national database showing everyones medical records. I can't understand how in the world they would find out I had this checkup...

Hi there,

When you fill out an application, you are legally obligated to fully disclose all information requested and answer the question's truthfully. THere tend to be questions on applications about whether or not you've got any outstanding medical issues that they'll need to know about. You would truthfully answer that you were diagnosed with an external hemroid, and then they'll want to know the name of that physician. They will request medical records most likely. It's not a matter of whether it's legal or not for the health plan to obtain that information. It's more about you being required to legally disclose all known information about your health condition.

If you were to not put that information on the application, and then say 4 months after you get coverage go to a doctor and have surgery, and the health insurance company discovers that this was something that you could have intentionally not disclosed on your application, that could be a much larger problem, where they could investigate all of your medical history to determine if you intentionally left information off.

You are correct however, that if you paid cash for the appointment, and a claim was not being filed with any health insurance company there would be way other than yourself that they would find that information.

Well when I signed up for my policy I had to give them complete access to my health records . You can try to deceive them but they have a thing called post-claim underwriting in which even after they have paid a claim they can retroactively
seek back all paid claims if they some how find out about your deception. I
wouldn't want that hanging over my head .You could end up in a bad way
financially.This has happened to people a year after they received treatment.
They were paying big bonuses to employees who dug up stuff people left
out of their application.

This sound like the smart thing to do. I would not tell anything about the hemorroid, not mention that doctor. Please an external hemorroid? That is no big deal at all. Millions of people have hemorroids, in fact I myself have an internal one and most likely will develop a number of external ones during my pregnancy now. Did the doctor said you will need a surgery? My best friend got treated for external hemorroid and all the doctor did was inject it with some medication and voila. I knew of a lady who did had hemorroid surgery but she really had a real bad case. Not one but several hemorroids and she had surgery like after 20 years of suffering of the hemorroids.

Would you give me $100 if I gave you $5? The insurance companies don't like this proposition either. You MUST disclose this if you are applying for an individual policy. Your coverage will likely exclude coverage for this however (riders vary based upon your resident state).

If you fail to disclose this and get approved without the insurance company finding out, they will rescind your coverage when they do find out (and they will).

Never lie on an insurance application. It's IMPOSSIBLE to beat the system.

Can't you just say the first one went away on its own and now this is a second one that you somehow got after you obtained insurance. I really doubt an insurance company is going to care about that bill. If you were to get cancer in the first year of coverage then they would go back and check to see if you had it before.

If they catch you lying, your policy will be rescinded and all claims with be denied. The insurance company might not catch a misrepresentation initially, but if you ever file a claim, they will do what's called a claim review. They will pull your medical records and if they find fraud, your policy will likely be rescinded.

Just tell the truth on your application. You existing condition will likely be ridered, but you should still be able to get insurance.

There are a few things to consider here.

#1: Insurance companies are EXPERTS in catching you lying.
#2: Insurance is for the "What if" not the "What is" (you wouldn't expect to buy auto insurance after you crashed your car, would you?)
#3: When you apply, all Insurance companies require that you "sign off" on your HIPAA rights so they can dig into your medical records.
#4: Non accident related conditions like this usually don't just "pop up." When you submit the claim, the insurance company will run you through the ringer with post claim underwriting.
#5: You're better off buying a discount card that will give you pre-negotiated rates at your local medical facility. you don't have to qualify because they don't pay anything. It's basically just a coupon.

On a side note, let this be a lesson to all of us. When people don't "pay into the system" when they're healthy, it causes all of our health insurance premiums to go up.

My health insurance premiums cost enough already. So please buy health insurance when you can. The excuse that "I'm healthy and therefore I don't need it" is DISGUSTING!

There are literally hundreds of plans to choose from so you really want to work with an experienced health insurance broker that can help you sort it all out and make sure you get the best policy for your needs.