Purposely NOT claiming on insurance Posted: 06-19-08 09:55am
I'm currently on COBRA, and have had a few
doctor's visits.
When COBRA runs out, I plan get my COBRA
converted to an individual policy.
When converting from COBRA ->
individual, does one have to fill out a
whole health questionnaire and medical
history?
If not, should I purposely hold out on
claiming my recent doctor's visits, since
that would lower my premiums for the
individual policy?
I don't want to do anything unethical or
illegal. Thanks!
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some0481
New User, Becoming EHEALTHy
Joined: 19 Jun 2008 Posts: 3
Posted: 06-19-08 14:25pm
Just to be clear: I do not want to lie or
omit vital information on an application.
But if my insurance carrier will never
give me an application, and instead base
the premiums on past claims, then should I
just pay for my recent doctor's visits
out-of-pocket, and never even submit these
claims?
Example:
Joe Smith has a COBRA policy, sees a
doctor, but DOES NOT submit it as a claim.
So the insurance company doesn't know
about the doctor's visit. When COBRA runs
out, the insurance company offers to
convert to an individual policy, without
asking Joe for a new application.
Jane Smith has a COBRA policy, sees a
doctor, but DOES submit it as a claim. So
the insurance company knows about the
doctor's visit. When COBRA runs out, the
insurance company offers to convert to an
individual policy, without asking Jane for
a new application.
My guess is that Joe has done nothing
wrong, since he was under no obligation to
claim his doctor's visit under COBRA, and
the insurance company never asked him
anything about it. My guess is further,
that Jane's individual policy will have a
higher premium than Joe's, since she has a
history of claims.
So, my questions are:
1. How common is it for insurance
companies to request a whole new
application with medical history, etc on
it, when converting from COBRA to an
individual policy?
2. Am I right that Joe has done nothing
wrong or unethical?
Thank you.
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some0481
New User, Becoming EHEALTHy
Joined: 19 Jun 2008 Posts: 3
Posted: 06-19-08 16:54pm
I'm going to submit the claims anyway. But
I would still like to continue this
discussion, and would greatly appreciate
continuing this thread, if only for my own
academic curiousity.
Why don't you want to submit the claims?
What benefit would that be to you? You're
paying out the a$$ for COBRA, and then you
will pay the full amount for a dr's visit
to cover it up?? I guess I don't
understand this.
Were the visits about a pre-existing
condition or something? Will you be
turning this COBRA account into an
individual account within the same
company??
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Coast Life and Health
New User, Becoming EHEALTHy
Joined: 12 Jul 2008 Posts: 5
Posted: 07-12-08 14:09pm
You would not gain anything by not
submitting your claims. If a co. has to
underwrite you they will get the info from
the MIB not from your past claims.
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CarolDiane
Moderator
Joined: 23 Sep 2007 Posts: 2392 Location: ,
Thanks: 111
Thanked:156
Posted: 07-12-08 14:17pm
I can understand your reasoning. But, been
through that myself when I left my long
term job and lost my insurance too. Cobra
in my state is about $400.00 a month! And
that is with a waver and pre-existing
illnesses. And I have many. When I go on
Medicare, I am sure my secondary insurance
will be at least $300.00 to $400.00 a
month. Not looking forward to that at all.
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katherinek74
New User, Becoming EHEALTHy
Joined: 13 Jul 2008 Posts: 5
COBRA to Individual policy Posted: 07-13-08 20:49pm
Hello there,
The individual application wants to know
about health conditions and recent
treatment, not necessarily if you've filed
a claim or not. So even though you
haven't been running the claims through
your COBRA coverage, you'll still need to
include that information on your
individual health application when you
apply for the individual coverage.
If in the process of requesting medical
records, and insurance company discovers
that you didn't disclose treatment for a
condition, it can be grounds to deny you a
policy.
It's best to give all the information.
Good luck!
Kathy K
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Jethro66
New User, Becoming EHEALTHy
Joined: 03 Aug 2008 Posts: 4
Posted: 08-03-08 20:49pm
I wouldn't try it because it could be a
small issue
and allow them to cancel you policy when
you need
it most and seek payment on all past paid
claims.
Very risky !They won't investigate you
until you file a claim of a significant
amount
and them try everything to not pay it so
don't
give them any ammunition.
