How do Insurance companies know if you have a pre-existing medical condition?

Question

Lets say you tell them you dont have any problems, then you get the health insurance then begin to see a doctor concerning your problem, knowing you have problems that should be treated, how will they know? WIll the doctor tell on you that you already had problems?

I have a bunch of problems and have seen other doctors about these problems, do they get records from other doctors? I donthave insurance and am trying to prevent my bills from escalating

Answer 1

i have had that problem in the past..... where something comes up and the insurance company denies the claim saying it is pre existing...... what i had to do was battle the insurance company...... i had to sign a release of my medical records to them, they did an investigation and since there was no proof it was pre existing they paid the claim......

if you sign a medical release to the insurance company...... and your doctor has treated you before for this condition, he isn't ratting you out...... he just sends them a copy of your records like you aproved him to do when you signed the release.

Answer 2

what the other person said is not true. i have worked for an insurance company with claims information for several years. this is what happens.

1) you go to the doctor and the doctor submits a claim to your insurance

2) when the claim is put in, certain diagnoses trigger a "red flag" saying that it COULD be pre-existing

3) the insurance company sends a letter to you to let you know a red flag came up, just as an FYI

4) the insurance company sends a similar letter to your dr, asking if the condition is pre-existing

5) if the doctor says yes, then the claim will be denied. if no, then the insurance will accept the claim.

keep in mind this will only happen for however long the pre-existing condition waiting period is. not usually longer than 6 months.

Answer 3

There is a datbase, called the Medical Information Bureau.

And, you hate living in America, because there are systems in place to catch liars, thieves, and cheats?   I don't think it's this country that is the problem here.

Answer 4

possess as much information as you could maybe is one of the options,however it is quite time consuming,here is the resource i have ever had good experience.http://health-insurance.onlinebestoffer....

Answer 5

How do they know?  Because you're not the first person to think of it.  If you buy insurance and tell them you're fine and start to make claims they'll be declined.  It's as simple as that

You SHOULD have purchased insurance before the conditions arose.  Many people blame the gov't for their own inactions.  There are still options available to you, but they won't be as attractive.  It would have been cheaper to be proactive....it always is.

Answer 6

I had a situation happen to me where my insurance company found out I had a pre-existing kidney condition. I heard from a Dr friend of mine that there is some database that hospitals share. Good luck to you.

Answer 7

There are a number of ways they can tell.  First, they may make you get a physical exam, which would show any pre-existing conditions.  Also, they may exclude serious illnesses for 6 months, which means you would not be able to seek treatment for them until the exclusionary period is up.  Also, there is a thing called the Medical Information Bureau in Massachusetts which collects medical information about people.  If you have a file, the insurance companies can access it to make a determination on rates, coverage, etc.  I have included a link to the MIB with information on how to request a copy of your file if there is one.

http://www.mib.com/html/contact_us.html

Note that if you have seen a doctor who has diagnosed an illness or condition that you fail to report on your application, it is considered fraud and if uncovered will most likely result in immediate termination of your policy and possible legal action for any benefits paid.

Answer 8

your story is confusing.  When you buy insurance ( any kind) you must declare previous history.  If you did'nt know you had medical problems prior to the insurance application then you did'nt do anything wrong.   It sounds like you did'nt declare your previous history and your new insurance company declined your claims because of non-disclosure.

Answer 9

Where I'm from, they have what is called the Medical Information Bureau and they also check in with your doctor to acquire medical records and "Attending Physicians Statements".  They may miss what ever your condition was, but if they find out, they can sue you for fraud.

Sorry to hear about your health conditions.  I have had many clients that have been in similar situations (including my own father).  What most of them have found to help them deal with the emotion of it is to tell their situations to everyone they know (not in a complaining manor, but in a 'motivating' way to help others understand the realities of life) and encourage them to look at insurances before they too become un-insurable.  Most find satisfaction in helping others before it's too late for them.