Should I report a preexisting condition to my health insurance company?

Question

I was under my father's military health care until the age of 23. Knowing this, I sought out and purchased individual health insurance through a writing agent that filled out the necessary information on the application. I was sent the information packet regarding my health coverage and I read that preexisting conditions include symptoms that were not diagnosed. Well, about 1 month before new my health coverage started, I went to the doctor regarding swollen tonsils. The doctor prescribed antibiotics and a strep throat test (which was negative), but there was no formal diagnosis. The issue is that during the application process my agent asked if there was anything wrong with me (in regards to medical conditions). I replied that there wasn't anything wrong with me that I have been diagnosed with. The problem is that my tonsils are still swollen and I would like to seek medical care. I am worried that the company will drop my coverage if I report this oversight or if I see a doctor.

Answer 1

Believe me, if you were treated (and that in and of itself defines a pre-existing condition), some kind of diagnosis was made. Unless the bill reflects this is a return visit for this diagnosis, the insurance company probably will not investigate further. The only way to accomplish this though, is to go to a different doctor and not mention the other visit to the new doctor. But tell the new doctor that you've been treated for this before and tell him what kind of antibiotic you had so he doesn't prescribe the same or similar. Now, I'm not advocating this--just answering your question.

You probably need a different antibiotic is all....

Answer 2

yes........

Answer 3

You were not diagnosed with anything before starting this policy so I don;t think they can complain. However they would probably check out your med records before agreeing to any payout or treatment.

Answer 4

Yes, you absolutely should always in every case report this visit as a pre-existing condition.

On every individual health insurance application there will be a question that is something to the effect of, "Have you been to the Doctor or a hospital in the last 12 months and received medical attention for anything besides a routine physical?"

If you answer this question no and the insurance company finds out later (which they almost always do because all medical information is shared using the Medical Information Bureau) then they have the right to cancel your policy.

Many people think that they are getting away with something when they tell these white lies but in reality if they ever have a very large claim and the insurance company starts to dig into their medical history (which they will) then they could very well not have any coverage due to their dishonesty.

You are doing the right thing in wanting to be honest and reveal this pre-existing condition.

Keep in mind that not all companies treat pre-existing conditions the same way so it can pay to shop around and compare.

Here is some more information on pre-existing conditions:

Answer 5

No no no no no no no no nono no no no no no no no no nono

Answer 6

Your insurance company has something called the MIB,(medical information bureau) they have listed EVERY time you've been to the Dr. even if it's for a sore throat. They also have what's called "intelliscript" it's a list of every script that's been written for you in the last 5 years. The MIB and intelliscript would have caught that you went to the Dr. last month for a sore throat and got antibiotics if that were the case.

If the Insurance company didn't like what the saw, they would have denied your insurance policy flat out.

I don't think that your ins company will deny any claims for a sore throat, that's what they're there for. To pay claims.

Answer 7

It sounds like you're being scrupulously honest, which is generally a good thing but which might get you in trouble in this regard.  You are obligated to tell the insurance company about any condition that was diagnosed in the past.  If it was not diagnosed, don't talk about it.  

In regard to your tonsils, just because you had one flare-up does not mean you are not going to be covered for another one.  Unless you had a diagnosis like "chronic tonsillitis" you are okay.  

Think about what the insurance company needs to know and what your obligation is very carefully before you volunteer information that might confuse the issue in the future.