View Full Version : Health insurance

01-21-04, 01:29 PM

I am about to sign up for new medical coverage after not having any for a few months. There is a section on the application under mental health asking specifically if myself or any of my dependents have been diagnosed, treated or received counseling during the past 5 years for Attention Deficit Disorder. They want to know patient's name (I never think of us as patience) date of dx, treatement received, date of last treatment and current status.

I don't know what to do about this. It is NOT an ethical conflict. Since when do insurance companies operate under the auspices of ethics? I just want to make sure we will recieve coverage for treatment of the condition. With our previous company we were covered pretty well and received treatment monthly if not more often.

I do not want to misrepresent intentionally on the application, but at the same time I do not want to be denied or have coverage terminated b/c somebody dug up some old records or somentig like that. Any advice would surely be appreciated.

01-21-04, 02:49 PM
Not much of a choice here since they will look up your old medical files before issuing coverage and find out *everything* anyway. You need to go with full disclosure. Maybe even going as far as getting your medical files to make sure you've covered everything and don't get accused of trying to hide anything.

Call the new insurance company's information line and ask them if they cover pre-existing conditions.

I had to switch insurance coverage part-way through my last pregnancy. Funny, I can remember this stuff from 4 years ago, but, don't ask me if I have plans tomorrow. Also, I am going by my swiss-cheese memory of this insurance switch nightmare, so, the details may not be all right, but, maybe it'll help to know the right question to ask.

Are you getting a policy through work or an individual policy? If you are getting one through work, you may be able to ask someone in HR if the insurance policy covers pre-exisiting conditions.

01-21-04, 07:25 PM
My DH is starting a new policy for his business. He and partner are only employees. I guess I AM HR. How can they get our medical records? I mean how will they know where to look?

01-22-04, 12:01 PM

Go down to Healthwiz's comment. I don't know more than that. And I try hard not to be paranoid about "big brother." But, I know that you have to give your social security number on the health insurance form and with that little number, they can find out a scary amount of information.

Did you get a chance to ask the new insurance if they cover pre-existing conditions? If they answer, "No." You might ask them if they have a plan that *does* cover pre-existing conditions. Some plans *do* cover pre-exisiting conditions, so shop around if you need too.

Good luck.

01-22-04, 01:23 PM
Thank you very much!

01-22-04, 03:22 PM
Your welcome :*)

04-10-07, 03:38 PM
Unfortunately, when you apply for an insurance policy, they can require you to disclose your entire medical history. They will find out about every diagnosis that was covered by medical insurance, every drug that was covered by medical insurance, every office visit covered by medical insurance etc. In other words, if insurance covered any part of a payment for something, the insurance company will find out.

Whatever you do, do not misrepresent this to the insurer. That is grounds to terminate your coverage. I promise you that the insurance company will find out and will terminate coverage. They might even try to void coverage retroactively by claiming that your coverage was actually in existence at the time they paid a claim because you made a misrepresentation on your policy.

I would ask about whether you will be covered for a pre-existing condition. If they say no, then I would advise you to keep shopping around for policies instead of omitting information about ADHD.

04-10-07, 04:32 PM
I agree with Wish. Discloseure is better than trying to hide anything. I believe they ask this question (I'm no expert) because in some states ADD is NOT considered a medical illness and therefore different coverage applies. Perhaps the administers of the plan support people in different states. They'd have to know this. Also depends on the state where the plan is official adminstered from. I've posted before on for "njtrout" and insurance. I'm in an insurance mess now, because I live in NJ, work in PA and plan is written out of Virginia. Triple wammy.


04-10-07, 06:46 PM
I think the reason they asked is because it's part of their underwriting process. They want to try to determine how much medical care you are likely to need and the likely cost of the medical care that you are likely to need; so that they can take that into account when pricing your policy. Indicators of the amount of medical care you will likely need and the cost of that medical care include: (1) the cost of them medications that you currently take, (2) the number of specialists you currently see, (3) how frequently you see specialists, (4) the cost of your current visits to specialists, (5) whether you've ever been hospitalized etc.

I've had an individual policy before, so I sympathize. I'm so glad that my current employer offers plans that cannot exclude pre-existing conditions.

04-10-07, 09:10 PM
Unfortunately in some States, Adult ADHD is not covered if you're on Medicaid. They will cover a child til the age of 19 or sometimes 22, depending on the type of Medicaid & the State.