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Guest
Guest
I have a question as a consumer (I apologize for the length). We have an individual health insurance policy with a well-known, large carrier. We went through all the pre-application questions, both with an agent for the paper application, and on the phone with a company rep. We disclosed everything, including surgery I had to put a fractured foot back together. My foot has a few pins it but I haven't seen a doctor for it in over a year and don't plan to. We were approved quickly with no riders.
A month and a half after we get the policy, I go the my internist for a routine physical. I tell her I've been tired, my periods have been a lot more irregular lately, blah, blah, but nothing major. She does a CBC, discovers I'm pretty anemic and refers me to a new GYN. The GYN sees me the following month, does an ultrasound to find out why I'm so out of whack and discovers a nice big (benign) fibroid. This is a total surprise to me. Then, as soon as our insurance provider gets this claim, they pend it and ask for records from the GYN. After my subsequent follow-up with her, they then ask for records from my internist. A few weeks after that, I get a letter with a bunch of forms, asking for a list of all the doctors I've seen in the past 5 yrs. and a consent form they want me to sign to get info from my doctors. The insurance company ends up denying both GYN claims, saying they're waiting on information from me and the providers.
Well, the providers sent in their records; I haven't sent in anything yet. Here's why - I went back and got the records from the previous GYN I'd seen a little over a year ago for my annual. I'd made some vague complaints about irregular periods then, but she passed it off as just getting older, it happens,etc. Turns out, however, in the records, she put down "menorrahagia" as a "diagnosis" for this (was not ever told to me) and also that I was "anemic" (again, not told to me; after reading this, I had a faint memory of her nurse telling me I was "low" on iron but that's it). So, the way I see it, I'm basically screwed if I consent to my older records being obtained because we didn't list these two things as "pre-existing" and they're on the application, plain as day. And, as it turns out, I will need some procedures to address this issue with the fibroid.
Obviously, had I known what was actually in those records, I would have disclosed it. I'm smart enough to know that it wouldn't benefit me not to do so. I'm afraid they'll rescind the policy because of this. Any thoughts? BTW, this is a company that supposedly doesn't do post-claim underwriting, based on an older post I'd read in this forum. Well, from here it sure seems like they do.
A month and a half after we get the policy, I go the my internist for a routine physical. I tell her I've been tired, my periods have been a lot more irregular lately, blah, blah, but nothing major. She does a CBC, discovers I'm pretty anemic and refers me to a new GYN. The GYN sees me the following month, does an ultrasound to find out why I'm so out of whack and discovers a nice big (benign) fibroid. This is a total surprise to me. Then, as soon as our insurance provider gets this claim, they pend it and ask for records from the GYN. After my subsequent follow-up with her, they then ask for records from my internist. A few weeks after that, I get a letter with a bunch of forms, asking for a list of all the doctors I've seen in the past 5 yrs. and a consent form they want me to sign to get info from my doctors. The insurance company ends up denying both GYN claims, saying they're waiting on information from me and the providers.
Well, the providers sent in their records; I haven't sent in anything yet. Here's why - I went back and got the records from the previous GYN I'd seen a little over a year ago for my annual. I'd made some vague complaints about irregular periods then, but she passed it off as just getting older, it happens,etc. Turns out, however, in the records, she put down "menorrahagia" as a "diagnosis" for this (was not ever told to me) and also that I was "anemic" (again, not told to me; after reading this, I had a faint memory of her nurse telling me I was "low" on iron but that's it). So, the way I see it, I'm basically screwed if I consent to my older records being obtained because we didn't list these two things as "pre-existing" and they're on the application, plain as day. And, as it turns out, I will need some procedures to address this issue with the fibroid.
Obviously, had I known what was actually in those records, I would have disclosed it. I'm smart enough to know that it wouldn't benefit me not to do so. I'm afraid they'll rescind the policy because of this. Any thoughts? BTW, this is a company that supposedly doesn't do post-claim underwriting, based on an older post I'd read in this forum. Well, from here it sure seems like they do.