So you hid some treatment for a medical condition from an insurance company; no big deal, right? Wrong!

Yesterday I spoke to one of my clients who had purchased a policy from me with a major company a little less than one year ago. In august of this year she had a major heart problem that required emergency surgery and spent a little over 2 weeks in the icu. Her bills are totalling around $300-350,000. Upon submition of the claims, the insurance company is going to review everything to try to get out of paying that kind of money. They found a small prescription issued a few years ago for irritable bowel syndrome that she never even took or refilled. In fact, she never even was really diagnosed with irritable bowel syndrome.

To make a long story short, the insurance carrier claimed that she wasn't being truthful on the application by not mentioning the above ibs medication and wanted to recind the policy all the way back to the effective date, refunding any premiums paid minus any claims filed. This would essentially get them out of the $300-350,000 liability and cause the client to be financially bankrupt. Luckily, we were able to come to an understanding with the insurance company and they will pay for the heart condition.

Blue cross is a good policy, but has some of the toughest underwriting guidelines. Normally, adhd is simply a rated or ridered condition. You have nothing to fear by calling the insurance company and telling them everything. Ask to speak to their underwriting department for individual medical. If they don't want you anymore, there are plenty of companies that will take you. Please do not put yourself in the same position my client did. It's simply not worth it.

Hope this helps.

Jason

Harriet:

i'm curious. In your message, you stated "i have health insurance now, it serves no purpose, I cant get my meds or go to appointments".

This confuses me greatly. What do you mean by "it serves no purpose"?

Harriet, you need to reevaluate why you are purchasing health insurance. Health insurance was never designed to pay the "small" items such as medications and doctor appointments. However, due to public pressure, insurance companies now offer coverage for these items.

Back to the question about why you are purchasing health insurance. If the reason is to get your meds and Dr. Paid, why would you pay such a high premium for such a small return.

In short, major medical health insurance is designed for the "big" items. $350,000 cancers, $200,000 heart surgeries, $1/2 million accidents, and so on. Big ticket procedures that your hospital is not obligated to perform if you do not have the "right" type of health insurance.

Don't sweat the small stuff.